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Mai Y, Cao Z, Zhao L, Yu Q, Xu J, Liu W, Liu B, Tang J, Luo Y, Liao W, Fang W, Ruan Y, Lei M, Mok VCT, Shi L, Liu J. The role of visual rating and automated brain volumetry in early detection and differential diagnosis of Alzheimer's disease. CNS Neurosci Ther 2024; 30:e14492. [PMID: 37864441 PMCID: PMC11017425 DOI: 10.1111/cns.14492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 09/07/2023] [Accepted: 09/26/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Medial temporal lobe atrophy (MTA) is a diagnostic marker for mild cognitive impairment (MCI) and Alzheimer's disease (AD), but the accuracy of quantitative MTA (QMTA) in diagnosing early AD is unclear. This study aimed to investigate the accuracy of QMTA and its related components (inferior lateral ventricle [ILV] and hippocampus) with MTA in the early diagnosis of MCI and AD. METHODS This study included four groups: normal (NC), MCI stable (MCIs), MCI converted to AD (MCIs), and mild AD (M-AD) groups. Magnetic resonance image analysis software was used to quantify the hippocampus, ILV, and QMTA. MTA was rated by two experienced neurologists. Receiver operating characteristic area under the curve (AUC) analysis was performed to compare their capability in differentiating AD from NC and MCI, and optimal thresholds were determined using the Youden index. RESULTS QMTA distinguished M-AD from NC and MCI with higher diagnostic accuracy than MTA, hippocampus, and ILV (AUCNC = 0.976, AUCMCI = 0.836, AUCMCIs = 0.894, AUCMCIc = 0.730). The diagnostic accuracy of QMTA was superior to that of MTA, the hippocampus, and ILV in differentiating MCI from AD. The diagnostic accuracy of QMTA was found to remain the best across age, sex, and pathological subgroups analyzed. The sensitivity (92.45%) and specificity (90.64%) were higher in this study when a cutoff value of 0.635 was chosen for QMTA. CONCLUSIONS QMTA may be a better choice than the MTA scale or the associated quantitative components alone in identifying AD patients and MCI individuals with higher progression risk.
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Affiliation(s)
- Yingren Mai
- Department of NeurologyThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Zhiyu Cao
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Lei Zhao
- BrainNow Research InstituteShenzhenChina
| | - Qun Yu
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Jiaxin Xu
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Wenyan Liu
- BrainNow Research InstituteShenzhenChina
| | - Bowen Liu
- Department of Statistics, College of Liberal Art and SciencesUniversity of Illinois Urbana‐ChampaignUrbanaIllinoisUSA
| | - Jingyi Tang
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Yishan Luo
- BrainNow Research InstituteShenzhenChina
| | - Wang Liao
- Department of NeurologyThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Wenli Fang
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Yuting Ruan
- Department of RehabilitationThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Ming Lei
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Vincent C. T. Mok
- BrainNow Research InstituteShenzhenChina
- Division of Neurology, Department of Medicine and Therapeutics, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative MedicineThe Chinese University of Hong KongHong Kong, SARChina
| | - Lin Shi
- BrainNow Research InstituteShenzhenChina
- Department of Imaging and Interventional RadiologyThe Chinese University of Hong KongHong Kong, SARChina
| | - Jun Liu
- Department of NeurologyThe Second Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
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Mukherjee S, Brown‐Bickerstaff C, Falkenstein A, Makinde AY, Bland E, Laney J, Garretson M, Huggar D, McBride A. Treatment patterns and outcomes with luspatercept in patients with lower-risk myelodysplastic syndromes: A retrospective US cohort analysis. Hemasphere 2024; 8:e38. [PMID: 38434524 PMCID: PMC10878180 DOI: 10.1002/hem3.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/08/2023] [Indexed: 03/05/2024] Open
Affiliation(s)
- Sudipto Mukherjee
- Department of Hematology and Medical OncologyTaussig Cancer Institute, Cleveland ClinicClevelandOhioUSA
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Bruce HA, Singer AU, Filippova EV, Blazer LL, Adams JJ, Enderle L, Ben‐David M, Radley EH, Mao DYL, Pau V, Orlicky S, Sicheri F, Kurinov I, Atwell S, Kossiakoff AA, Sidhu SS. Engineered antigen-binding fragments for enhanced crystallization of antibody:antigen complexes. Protein Sci 2024; 33:e4824. [PMID: 37945533 PMCID: PMC10731619 DOI: 10.1002/pro.4824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/09/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Abstract
The atomic-resolution structural information that X-ray crystallography can provide on the binding interface between a Fab and its cognate antigen is highly valuable for understanding the mechanism of interaction. However, many Fab:antigen complexes are recalcitrant to crystallization, making the endeavor a considerable effort with no guarantee of success. Consequently, there have been significant steps taken to increase the likelihood of Fab:antigen complex crystallization by altering the Fab framework. In this investigation, we applied the surface entropy reduction strategy coupled with phage-display technology to identify a set of surface substitutions that improve the propensity of a human Fab framework to crystallize. In addition, we showed that combining these surface substitutions with previously reported Crystal Kappa and elbow substitutions results in an extraordinary improvement in Fab and Fab:antigen complex crystallizability, revealing a strong synergistic relationship between these sets of substitutions. Through comprehensive Fab and Fab:antigen complex crystallization screenings followed by structure determination and analysis, we defined the roles that each of these substitutions play in facilitating crystallization and how they complement each other in the process.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Daniel Y. L. Mao
- Lunenfeld‐Tanenbaum Research InstituteSinai Health SystemTorontoCanada
| | - Victor Pau
- Lunenfeld‐Tanenbaum Research InstituteSinai Health SystemTorontoCanada
| | - Stephen Orlicky
- Lunenfeld‐Tanenbaum Research InstituteSinai Health SystemTorontoCanada
| | - Frank Sicheri
- Lunenfeld‐Tanenbaum Research InstituteSinai Health SystemTorontoCanada
- Departments of Biochemistry and Molecular GeneticsUniversity of TorontoOntarioCanada
| | | | | | - Anthony A. Kossiakoff
- Department of Biochemistry and Molecular BiologyUniversity of ChicagoChicagoIllinoisUSA
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Yoon D, Jeong HE, Choi S, Lee D, Shin J, Bang S. Heterogeneous distributions in clinical events preceding anticoagulant treatment nonpersistence in patients with venous thromboembolism stratified by active cancer: A nationwide cohort study. Cancer Med 2023; 12:20538-20543. [PMID: 37882319 PMCID: PMC10660092 DOI: 10.1002/cam4.6626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/25/2023] [Accepted: 09/30/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Nonpersistence in anticoagulation therapy is common and associated with undesirable clinical outcomes in patients with venous thromboembolism (VTE). METHODS We investigated preceding clinical events of treatment nonpersistence (e.g., switching, discontinuing, or restarting) in VTE patients with and without active cancer using Korean claims database. RESULTS Clinically significant events including thromboembolic events, hepatic function change and surgery preceded treatment nonpersistence, but heterogeneous distributions of clinical events were observed in the presence of active cancer. Patients with active cancer had a low rate of clinical events preceding treatment nonpersistence, and new active cancer diagnosis in the nonactive cancer group was most common before the switch to parenteral anticoagulants from warfarin or non-vitamin K antagonist oral anticoagulants (NOACs). CONCLUSION These findings suggest that clinically significant events can precede treatment nonpersistence and largely paralleled current guidelines for patients with VTE, whereas heterogeneous distributions of clinical events were observed in the presence of active cancer.
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Affiliation(s)
- Dongwon Yoon
- School of PharmacySungkyunkwan UniversitySuwonSouth Korea
- Department of Biohealth Regulatory ScienceSungkyunkwan UniversitySuwonSouth Korea
| | - Han Eol Jeong
- School of PharmacySungkyunkwan UniversitySuwonSouth Korea
- Department of Biohealth Regulatory ScienceSungkyunkwan UniversitySuwonSouth Korea
| | - Songhwa Choi
- Medical AffairsPfizer Korea Ltd.SeoulSouth Korea
| | - Daye Lee
- Medical AffairsPfizer Korea Ltd.SeoulSouth Korea
| | - Ju‐Young Shin
- School of PharmacySungkyunkwan UniversitySuwonSouth Korea
- Department of Biohealth Regulatory ScienceSungkyunkwan UniversitySuwonSouth Korea
- Samsung Advanced Institute for Health Sciences & TechnologySungkyunkwan UniversitySeoulSouth Korea
| | - Soo‐Mee Bang
- Division of Hemato‐Oncology, Department of Internal Medicine, Seoul National University College of MedicineSeoul National University Bundang HospitalSeongnamSouth Korea
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Hamatani Y, Iguchi M, Minami K, Ishigami K, Esato M, Tsuji H, Wada H, Hasegawa K, Ogawa H, Abe M, Lip GY, Akao M. Utility of left ventricular ejection fraction in atrial fibrillation patients without pre-existing heart failure. ESC Heart Fail 2023; 10:3091-3101. [PMID: 37604489 PMCID: PMC10567650 DOI: 10.1002/ehf2.14500] [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: 11/01/2022] [Revised: 06/26/2023] [Accepted: 07/27/2023] [Indexed: 08/23/2023] Open
Abstract
AIMS Atrial fibrillation (AF) increases the risk of heart failure (HF); however, little focus has been placed on the prevention of HF in patients with AF. Left ventricular ejection fraction (LVEF) is an established echocardiographic parameter in HF patients. We sought to investigate the association of LVEF with HF events in AF patients without pre-existing HF. METHODS AND RESULTS The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Japan. In this analysis, we excluded patients with pre-existing HF (defined as having one of the following: prior HF hospitalization, New York Heart Association class ≥ 2 in association with heart disease, or LVEF < 40%). Among 3233 AF patients without pre-existing HF, we investigated 2459 patients with the data of LVEF at enrolment. We divided the patients into three groups stratified by LVEF [mildly reduced LVEF (40-49%), below normal LVEF (50-59%), and normal LVEF (≥60%)] and compared the backgrounds and incidence of HF hospitalization between the groups. Of 2459 patients [mean age: 72.4 ± 10.5 years, female: 917 (37%), paroxysmal AF: 1405 (57%), and mean CHA2 DS2 -VASc score: 3.0 ± 1.6], the mean LVEF was 66 ± 8% [mildly reduced LVEF: 114 patients (5%), below normal LVEF: 300 patients (12%), and normal LVEF: 2045 patients (83%)]. Patients with lower LVEF demonstrated lower prevalence of female and paroxysmal AF (both P < 0.01), but age and CHA2 DS2 -VASc score were comparable between the three groups (both P > 0.05). During the median follow-up period of 6.0 years, 255 patients (10%) were hospitalized for HF (annual incidence: 1.9% per person-year). Multivariable Cox regression analysis demonstrated that lower LVEF strata were independently associated with the risk of HF [mildly reduced LVEF (40-49%): hazard ratio = 2.98, 95% confidence interval = 1.99-4.45 and below normal LVEF (50-59%): hazard ratio = 2.01, 95% confidence interval = 1.44-2.82, compared with normal LVEF (≥60%)] after adjustment by age, sex, type of AF, and CHA2 DS2 -VASc score. LVEF < 60% was significantly associated with the higher risk of HF hospitalization across all major subgroups without significant interaction (P for interaction; all P > 0.05). LVEF had an independent and incremental prognostic value for HF hospitalization in addition to natriuretic peptide levels in AF patients without pre-existing HF. CONCLUSIONS Lower LVEF was significantly associated with the higher incidence of HF hospitalization in AF patients without pre-existing HF, leading to the future risk stratification for and prevention of incident HF in AF patients.
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Affiliation(s)
- Yasuhiro Hamatani
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Moritake Iguchi
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Kimihito Minami
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Kenjiro Ishigami
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Masahiro Esato
- Department of ArrhythmiaOgaki Tokushukai HospitalGifuJapan
| | | | - Hiromichi Wada
- Division of Translational ResearchNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Koji Hasegawa
- Division of Translational ResearchNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Hisashi Ogawa
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Mitsuru Abe
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Gregory Y.H. Lip
- Liverpool Center for Cardiovascular ScienceUniversity of Liverpool and Liverpool Heart and Chest HospitalLiverpoolUK
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Masaharu Akao
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
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Manning E, Burns K, Laurie M, Patten L, Ho M, Sandhu A. Factors associated with oral anticoagulant prescription status among patients with a new diagnosis of atrial fibrillation. Clin Cardiol 2023; 46:937-941. [PMID: 37401357 PMCID: PMC10436786 DOI: 10.1002/clc.24077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common sustained arrhythmia in adults and increases stroke risk. Treatment with oral anticoagulants (OACs) may reduce this risk however many patients do not receive OAC therapy. This study aimed to use electronic health record data to identify newly diagnosed AF patients at high risk for stroke and not anticoagulated as well as factors associated with OAC prescription. HYPOTHESIS Timely prescription of OACs among patients with newly diagnosed AF is poor. METHODS We performed a retrospective study of patients with a new diagnosis of AF. We assessed stroke risk with the CHA2 DS2 -VASc score. The primary outcome was prescription of an OAC within 6 months following diagnosis. We used logistic regression to see how the odds of being prescribed an OAC differs for 17 independent variables. RESULTS We identified 18 404 patients with a new diagnosis of AF. Among patients at high risk for stroke, 41.3% received an OAC prescription within 6 months. Male sex, Caucasian compared to African American race, stroke, obesity, congestive heart failure, vascular disorder, current antiplatelet, beta blocker, or calcium channel blocker prescription, and increasing CHA2 DS2 -VASc score were positively associated with receiving an OAC. Whereas anemia, renal dysfunction, liver dysfunction, antiarrhythmic drug use and increasing HAS-BLED score were negatively associated. CONCLUSIONS Most newly diagnosed AF patients at high stroke risk do not receive an OAC prescription in the first 6 months following diagnosis. Our analysis suggests that patient sex, race, comorbidities, and additional prescriptions are associated with rates of OAC prescribing.
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Affiliation(s)
- Evan Manning
- Internal Medicine Residency Training ProgramUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Kelley Burns
- Data Science to Patient Value (D2V)University of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Melissa Laurie
- US Health Economics & Outcomes ResearchBristol Myers SquibbLawrencevilleNew JerseyUSA
| | - Luke Patten
- Center for Innovative Design & AnalysisUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Michael Ho
- Deparment of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Amneet Sandhu
- Deparment of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
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Ellenbogen MI, Ardeshirrouhanifard S, Segal JB, Streiff MB, Deitelzweig SB, Brotman DJ. Safety and effectiveness of apixaban versus warfarin for acute venous thromboembolism in patients with end-stage kidney disease: A national cohort study. J Hosp Med 2022; 17:809-818. [PMID: 35929542 PMCID: PMC9804323 DOI: 10.1002/jhm.12926] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/04/2022] [Accepted: 07/10/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Patients with end-stage kidney disease (ESKD) are at significantly increased risk for both thrombosis and bleeding relative to those with normal renal function. The optimal therapy of venous thromboembolism (VTE) in patients with ESKD is unknown. OBJECTIVE To compare the safety and effectiveness of apixaban relative to warfarin in patients with ESKD and acute VTE. DESIGN, SETTING AND PARTICIPANTS New-user, active-comparator retrospective United States population-based cohort with inverse probability of treatment weighting, using the United States Renal Data System data from 2014 to 2018. We included adults with ESKD on hemodialysis or peritoneal dialysis who were newly initiated on apixaban or warfarin for an acute VTE. MAIN OUTCOME AND MEASURES The coprimary outcomes were major bleeding, recurrent VTE, and all-cause mortality within 6 months of anticoagulant initiation. Secondary outcomes were intracranial hemorrhage and gastrointestinal bleeding. The primary analyses were based on intent-to-treat defined by the first drug received and accounted for competing risks of death. Sensitivity analyses included varied follow-up time, as-treated analyses, and dose-specific apixaban subgroups. RESULTS The apixaban and warfarin cohorts included 2302 and 9263 patients, respectively. Apixaban was associated with a lower risk of major bleeding (hazard ratio [HR] 0.81, 95% confidence interval [CI]: 0.70-0.94), intracranial bleeding (HR 0.69, 95% CI 0.48-0.98), and gastrointestinal bleeding (HR 0.82, 95% CI 0.69-0.96). Recurrent VTE and all-cause mortality were not significantly different between the groups. CONCLUSION Apixaban was associated with a lower risk of bleeding relative to warfarin when used to treat acute VTE in patients with ESKD on dialysis.
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Affiliation(s)
- Michael I. Ellenbogen
- Department of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Hopkins Business of Health InitiativeJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Jodi B. Segal
- Department of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of Health Policy and Management, and EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Michael B. Streiff
- Departments of Medicine and PathologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | | | - Daniel J. Brotman
- Department of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
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Uhara H, Tsuchida T, Kiyohara Y, Akamatsu A, Sakamoto T, Yamazaki N. Safety and effectiveness of nivolumab in Japanese patients with malignant melanoma: Final analysis of a post-marketing surveillance. J Dermatol 2022; 49:862-871. [PMID: 35607248 PMCID: PMC9545090 DOI: 10.1111/1346-8138.16432] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 11/30/2022]
Abstract
Nivolumab, a monoclonal antibody against human programmed death 1, was approved for the treatment of melanoma in July 2014 in Japan. Because the Japanese phase II studies (ONO-4538-02, ONO-4538-08) enrolled small numbers of melanoma patients, post-marketing surveillance (PMS; JapicCTI-163 272) was conducted to collect safety data in a larger patient population. We report data for melanoma patients who received nivolumab between July 4, 2014 and February 28, 2017. Data collected included baseline characteristics, laboratory tests, treatment-related adverse events (TRAE), and overall survival (OS). Of 2069 enrolled patients, 2008 patients were included in the safety analysis population. There were 1030 (51.3%) males, the median age was 69 years, and 269 patients (13.4%) had a performance status of ≥2. The primary tumor sites were cutaneous (34.4%), mucosal (34.2%), acral lentiginous (18.6%), others (6.8%), and unknown (6.3%). TRAE occurred in 62.1% of patients, the most common being hypothyroidism (14.0%), increased aspartate aminotransferase (8.5%), and increased alanine aminotransferase (6.9%). TRAE of special interest in ≥5% of patients were thyroid dysfunction (24.9%), hepatic dysfunction (20.6%), infusion reactions (11.4%), colitis/severe diarrhea (6.3%), and interstitial lung disease (ILD; 5.0%). Several types of TRAE of special interest, which included myasthenia gravis/myocarditis/myositis/rhabdomyolysis (0.9%), venous thromboembolism (0.2%), immune thrombocytopenic purpura (0.1%), and encephalitis (0.0%), were observed in this PMS. Although these TRAE were not reported in previous studies (ONO-4538-02, ONO-4538-08, CheckMate 066, and CheckMate 037), they have been listed in the current Risk Management Plan. History of ILD and male sex were risk factors for ILD in a multivariable analysis. Age <75 years was a risk factor for hepatic dysfunction. At 12 months, median OS was not reached. In conclusion, these results suggested that there was no concern requiring additional precautions for the safety of nivolumab in Japanese patients with melanoma other than the safety information in the Risk Management Plan.
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Affiliation(s)
- Hisashi Uhara
- Department of DermatologySapporo Medical University School of MedicineSapporoJapan
| | | | - Yoshio Kiyohara
- Dermatology DivisionShizuoka Cancer Center HospitalShizuokaJapan
| | | | | | - Naoya Yamazaki
- Department of Dermatologic OncologyNational Cancer Center HospitalTokyoJapan
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Wong PC, Crain EJ, Bozarth JM, Wu Y, Dilger AK, Wexler RR, Ewing WR, Gordon D, Luettgen JM. Milvexian, an orally bioavailable, small-molecule, reversible, direct inhibitor of factor XIa: In vitro studies and in vivo evaluation in experimental thrombosis in rabbits. J Thromb Haemost 2022; 20:399-408. [PMID: 34752670 PMCID: PMC9299130 DOI: 10.1111/jth.15588] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/12/2021] [Accepted: 11/05/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Milvexian (BMS-986177/JNJ-70033093) is an orally bioavailable factor XIa (FXIa) inhibitor currently in phase 2 clinical trials. OBJECTIVES To evaluate in vitro properties and in vivo characteristics of milvexian. METHODS In vitro properties of milvexian were evaluated with coagulation and enzyme assays, and in vivo profiles were characterized with rabbit models of electrolytic-induced carotid arterial thrombosis and cuticle bleeding time (BT). RESULTS Milvexian is an active-site, reversible inhibitor of human and rabbit FXIa (Ki 0.11 and 0.38 nM, respectively). Milvexian increased activated partial thromboplastin time (APTT) without changing prothrombin time and potently prolonged plasma APTT in humans and rabbits. Milvexian did not alter platelet aggregation to ADP, arachidonic acid, or collagen. Milvexian was evaluated for in vivo prevention and treatment of thrombosis. For prevention, milvexian 0.063 + 0.04, 0.25 + 0.17, and 1 + 0.67 mg/kg+mg/kg/h preserved 32 ± 6*, 54 ± 10*, and 76 ± 5%* of carotid blood flow (CBF) and reduced thrombus weight by 15 ± 10*, 45 ± 2*, and 70 ± 4%*, respectively (*p < .05; n = 6/dose). For treatment, thrombosis was initiated for 15 min and CBF decreased to 40% of control. Seventy-five minutes after milvexian administration, CBF averaged 1 ± 0.3, 39 ± 10, and 66 ± 2%* in groups treated with vehicle and milvexian 0.25 + 0.17 and 1 + 0.67 mg/kg+mg/kg/h, respectively (*p < .05 vs. vehicle; n = 6/group). The combination of milvexian 1 + 0.67 mg/kg+mg/kg/h and aspirin 4 mg/kg/h intravenous did not increase BT versus aspirin monotherapy. CONCLUSIONS Milvexian is an effective antithrombotic agent with limited impact on hemostasis, even when combined with aspirin in rabbits. This study supports inhibition of FXIa with milvexian as a promising antithrombotic therapy with a wide therapeutic window.
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Affiliation(s)
- Pancras C. Wong
- Cardiovascular and Fibrosis Drug Discovery BiologyBristol Myers Squibb CompanyPrincetonNew JerseyUSA
| | - Earl J. Crain
- Cardiovascular and Fibrosis Drug Discovery BiologyBristol Myers Squibb CompanyPrincetonNew JerseyUSA
| | - Jeffrey M. Bozarth
- Cardiovascular and Fibrosis Drug Discovery BiologyBristol Myers Squibb CompanyPrincetonNew JerseyUSA
| | - Yiming Wu
- Cardiovascular and Fibrosis Drug Discovery BiologyBristol Myers Squibb CompanyPrincetonNew JerseyUSA
| | - Andrew K. Dilger
- Cardiovascular Drug Discovery ChemistryBristol Myers Squibb CompanyPrincetonNew JerseyUSA
| | - Ruth R. Wexler
- Cardiovascular Drug Discovery ChemistryBristol Myers Squibb CompanyPrincetonNew JerseyUSA
| | - William R. Ewing
- Cardiovascular Drug Discovery ChemistryBristol Myers Squibb CompanyPrincetonNew JerseyUSA
| | - David Gordon
- Cardiovascular and Fibrosis Drug Discovery BiologyBristol Myers Squibb CompanyPrincetonNew JerseyUSA
| | - Joseph M. Luettgen
- Cardiovascular and Fibrosis Drug Discovery BiologyBristol Myers Squibb CompanyPrincetonNew JerseyUSA
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Tamura T, Ninomiya K, Kubo T, Kuyama S, Tachibana S, Inoue K, Chikamori K, Kudo K, Ochi N, Harada D, Maeda Y, Kiura K. Short-term safety of an anti-severe acute respiratory syndrome coronavirus 2 messenger RNA vaccine for patients with advanced lung cancer treated with anticancer drugs: A multicenter, prospective, observational study. Thorac Cancer 2022; 13:453-459. [PMID: 34964270 PMCID: PMC8807248 DOI: 10.1111/1759-7714.14281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Since 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become prevalent worldwide. In severe cases, the case fatality rate is high, and vaccine prevention is important. This study evaluated the safety of receiving SARS-CoV-2 vaccine in patients with advanced lung cancer receiving anticancer therapy. METHODS We prospectively enrolled patients receiving anticancer drugs for advanced lung cancer who planned to receive SARS-CoV-2 vaccination. Early adverse events within 7 days of vaccine injection were evaluated using patient-reported surveys. The chi-square test and multivariate logistic regression analyses were used. RESULTS Among 120 patients receiving lung cancer treatment, 73 were men; the mean age of the patients was 73.5 years. The treatments received for lung cancer at the time of the first vaccine injection were chemotherapy, ICIs, combined chemotherapy and ICIs, and targeted therapies, including tyrosine kinase inhibitors, in 30, 28, 17, and 45 patients, respectively. All patients received SARS-CoV-2 messenger RNA (mRNA) vaccine. After the second mRNA vaccine dose, 15.4% of patients had fever of 38°C (95% confidence interval: 9.34%-23.2%); this rate was slightly higher than that for healthy participants at the time of the BNT162b2 trial. Patients treated with cytotoxic anticancer drugs tended to have high fever. In the multivariate analyses, male sex was associated with higher fever frequencies. However, there were no serious early adverse events due to vaccination. CONCLUSIONS Anti-SARS-CoV-2 mRNA vaccination tends to be safe, but fever following vaccination tends to be more common among patients undergoing lung cancer treatment than among healthy individuals.
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Affiliation(s)
- Tomoki Tamura
- Department of Respiratory MedicineNHO Iwakuni Clinical CenterIwakuniJapan
| | - Kiichiro Ninomiya
- Department of Hematology, Oncology and Respiratory MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Toshio Kubo
- Center for Clinical OncologyOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Shoichi Kuyama
- Department of Respiratory MedicineNHO Iwakuni Clinical CenterIwakuniJapan
| | - Sayaka Tachibana
- Department of Respiratory MedicineEhime Prefectural Central HospitalMatsuyamaJapan
| | - Koji Inoue
- Department of Respiratory MedicineEhime Prefectural Central HospitalMatsuyamaJapan
| | - Kenichi Chikamori
- Department of Medical OncologyNational Hospital Organization Yamaguchi‐Ube Medical CenterUbeJapan
| | - Kenichiro Kudo
- Department of Respiratory MedicineNational Hospital Organization Okayama Medical CenterOkayamaJapan
| | - Nobuaki Ochi
- General Internal Medicine 4Kawasaki Medical SchoolOkayamaJapan
| | - Daijiro Harada
- Department of Thoracic OncologyNHO Shikoku Cancer CenterMatsuyamaJapan
| | - Yoshinobu Maeda
- Department of Hematology, Oncology and Respiratory MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Katsuyuki Kiura
- Department of Allergy and Respiratory MedicineOkayama University HospitalOkayamaJapan
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11
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van der Leest P, Hiddinga B, Miedema A, Aguirre Azpurua ML, Rifaela N, ter Elst A, Timens W, Groen HJM, van Kempen LC, Hiltermann TJN, Schuuring E. Circulating tumor DNA as a biomarker for monitoring early treatment responses of patients with advanced lung adenocarcinoma receiving immune checkpoint inhibitors. Mol Oncol 2021; 15:2910-2922. [PMID: 34449963 PMCID: PMC8564646 DOI: 10.1002/1878-0261.13090] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/27/2021] [Accepted: 08/25/2021] [Indexed: 11/07/2022] Open
Abstract
Immunotherapy for metastasized non-small-cell lung cancer (NSCLC) can show long-lasting clinical responses. Selection of patients based on programmed death-ligand 1 (PD-L1) expression shows limited predictive value for durable clinical benefit (DCB). We investigated whether early treatment effects as measured by a change in circulating tumor DNA (ctDNA) level is a proxy of early tumor response to immunotherapy according to response evaluation criteria in solid tumors v1.1 criteria, progression-free survival (PFS), DCB, and overall survival (OS). To this aim, blood tubes were collected from advanced-stage lung adenocarcinoma patients (n = 100) receiving immune checkpoint inhibitors (ICI) at baseline (t0 ) and prior to first treatment evaluation (4-6 weeks; t1 ). Nontargetable (driver) mutations detected in the pretreatment tumor biopsy were used to quantify tumor-specific ctDNA levels using droplet digital PCR. We found that changes in ctDNA levels were strongly associated with tumor response. A > 30% decrease in ctDNA at t1 correlated with a longer PFS and OS. In total, 80% of patients with a DCB of ≥ 26 weeks displayed a > 30% decrease in ctDNA levels. For patients with a PD-L1 tumor proportion score of ≥ 1%, decreasing ctDNA levels were associated with a higher frequency a DCB (80%) and a prolonged median PFS (85 weeks) and OS (101 weeks) compared with patients with no decrease in ctDNA (34%; 11 and 39 weeks, respectively). This study shows that monitoring of ctDNA dynamics is an easy-to-use and promising tool for assessing PFS, DCB, and OS for ICI-treated NSCLC patients.
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Affiliation(s)
- Paul van der Leest
- Department of PathologyUniversity of GroningenUniversity Medical Center GroningenThe Netherlands
| | - Birgitta Hiddinga
- Department of Pulmonary DiseasesUniversity of GroningenUniversity Medical Center GroningenThe Netherlands
| | - Anneke Miedema
- Department of PathologyUniversity of GroningenUniversity Medical Center GroningenThe Netherlands
| | - Maria L. Aguirre Azpurua
- Department of PathologyUniversity of GroningenUniversity Medical Center GroningenThe Netherlands
| | - Naomi Rifaela
- Department of PathologyUniversity of GroningenUniversity Medical Center GroningenThe Netherlands
| | - Arja ter Elst
- Department of PathologyUniversity of GroningenUniversity Medical Center GroningenThe Netherlands
| | - Wim Timens
- Department of PathologyUniversity of GroningenUniversity Medical Center GroningenThe Netherlands
| | - Harry J. M. Groen
- Department of Pulmonary DiseasesUniversity of GroningenUniversity Medical Center GroningenThe Netherlands
| | - Léon C. van Kempen
- Department of PathologyUniversity of GroningenUniversity Medical Center GroningenThe Netherlands
| | - T. Jeroen N. Hiltermann
- Department of Pulmonary DiseasesUniversity of GroningenUniversity Medical Center GroningenThe Netherlands
| | - Ed Schuuring
- Department of PathologyUniversity of GroningenUniversity Medical Center GroningenThe Netherlands
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12
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van Zeijl MCT, van den Eertwegh AJM, Wouters MWJM, de Wreede LC, Aarts MJB, van den Berkmortel FWPJ, de Groot JB, Hospers GAP, Kapiteijn E, Piersma D, van Rijn RS, Suijkerbuijk KPM, ten Tije AJ, van der Veldt AAM, Vreugdenhil G, van der Hoeven JJM, Haanen JBAG. Discontinuation of anti-PD-1 monotherapy in advanced melanoma-Outcomes of daily clinical practice. Int J Cancer 2021; 150:317-326. [PMID: 34520567 PMCID: PMC9293478 DOI: 10.1002/ijc.33800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/14/2021] [Accepted: 05/17/2021] [Indexed: 01/22/2023]
Abstract
There is no consensus on the optimal treatment duration of anti-PD-1 for advanced melanoma. The aim of our study was to gain insight into the outcomes of anti-PD-1 discontinuation, the association of treatment duration with progression and anti-PD-1 re-treatment in relapsing patients. Analyses were performed on advanced melanoma patients in the Netherlands who discontinued first-line anti-PD-1 monotherapy in the absence of progressive disease (n = 324). Survival was estimated after anti-PD-1 discontinuation and with a Cox model the association of treatment duration with progression was assessed. At the time of anti-PD-1 discontinuation, 90 (28%) patients had a complete response (CR), 190 (59%) a partial response (PR) and 44 (14%) stable disease (SD). Median treatment duration for patients with CR, PR and SD was 11.2, 11.5 and 7.2 months, respectively. The 24-month progression-free survival and overall survival probabilities for patients with a CR, PR and SD were, respectively, 64% and 88%, 53% and 82%, 31% and 64%. Survival outcomes of patients with a PR and CR were similar when anti-PD-1 discontinuation was not due to adverse events. Having a PR at anti-PD-1 discontinuation and longer time to first response were associated with progression [hazard ratio (HR) = 1.81 (95% confidence interval, CI = 1.11-2.97) and HR = 1.10 (95% CI = 1.02-1.19; per month increase)]. In 17 of the 27 anti-PD-1 re-treated patients (63%), a response was observed. Advanced melanoma patients can have durable remissions after (elective) anti-PD-1 discontinuation.
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Affiliation(s)
- Michiel C. T. van Zeijl
- Scientific DepartmentDutch Institute for Clinical AuditingLeidenThe Netherlands
- Department of Medical OncologyLeiden University Medical CenterLeidenThe Netherlands
| | | | - Michel W. J. M. Wouters
- Scientific DepartmentDutch Institute for Clinical AuditingLeidenThe Netherlands
- Department of Surgical OncologyNetherlands Cancer InstituteAmsterdamThe Netherlands
- Department of Biomedical Data SciencesLeiden University Medical CenterLeidenThe Netherlands
| | - Liesbeth C. de Wreede
- Department of Biomedical Data SciencesLeiden University Medical CenterLeidenThe Netherlands
| | - Maureen J. B. Aarts
- Department of Medical OncologyMaastricht University Medical Center+MaastrichtThe Netherlands
| | | | | | - Geke A. P. Hospers
- Department of Medical OncologyUniversity Medical Center GroningenGroningenThe Netherlands
| | - Ellen Kapiteijn
- Department of Medical OncologyLeiden University Medical CenterLeidenThe Netherlands
| | - Djura Piersma
- Department of Internal MedicineMedical Spectrum TwenteEnschedeThe Netherlands
| | | | | | | | | | - Gerard Vreugdenhil
- Department of Internal MedicineMaxima Medical CenterEindhovenThe Netherlands
| | | | - John B. A. G. Haanen
- Divisions of Medical Oncology and Molecular Oncology and ImmunologyNetherlands Cancer InstituteAmsterdamThe Netherlands
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13
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Asad H, Collins IJ, Goodall RL, Crichton S, Hill T, Doerholt K, Foster C, Lyall H, Post FA, Welch S, Winston A, Sabin CA, Judd A. Mortality and AIDS-defining events among young people following transition from paediatric to adult HIV care in the UK. HIV Med 2021; 22:631-640. [PMID: 33939876 PMCID: PMC8612219 DOI: 10.1111/hiv.13096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To investigate risk of AIDS and mortality after transition from paediatric to adult care in a UK cohort of young people with perinatally acquired HIV. METHODS Records of people aged ≥ 13 years on 31 December 2015 in the UK paediatric HIV cohort (Collaborative HIV Paediatric Study) were linked to those of adults in the UK Collaborative HIV Cohort (CHIC) cohort. We calculated time from transition to a new AIDS event/death, with follow-up censored at the last visit or 31 December 2015, whichever was the earliest. Cumulative incidence of and risk factors for AIDS/mortality were assessed using Kaplan-Meier and Cox regression. RESULTS At the final paediatric visit, the 474 participants [51% female, 80% black, 60% born outside the UK, median (interquartile range) age at antiretroviral therapy (ART) initiation = 9 (5-13) years] had a median age of 18 (17-19) years and CD4 count of 471 (280-663) cell/μL; 89% were prescribed ART and 60% overall had a viral load ≤ 400 copies/mL. Over median follow-up in adult care of 3 (2-6) years, 35 (8%) experienced a new AIDS event (n = 25) or death (n = 14) (incidence = 1.8/100 person-years). In multivariable analyses, lower CD4 count at the last paediatric visit [adjusted hazard ratio = 0.8 (95% confidence interval: 0.7-1.0)/100 cells/μL increment] and AIDS diagnosis in paediatric care [2.7 (1.4-5.5)] were associated with a new AIDS event/mortality in adult care. CONCLUSIONS Young people with perinatally acquired HIV transitioning to adult care with markers of disease progression in paediatric care experienced poorer outcomes in adult care. Increased investment in multidisciplinary specialized services is required to support this population at high risk of morbidity and mortality.
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Affiliation(s)
- H Asad
- MRC Clinical Trials Unit at UCLUniversity College London (UCL)LondonUK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood‐Borne and Sexually Transmitted InfectionsUCL in partnership with Public Health EnglandLondonUK
- Institute for Global HealthUCLLondonUK
| | - IJ Collins
- MRC Clinical Trials Unit at UCLUniversity College London (UCL)LondonUK
| | - RL Goodall
- MRC Clinical Trials Unit at UCLUniversity College London (UCL)LondonUK
- Institute for Global HealthUCLLondonUK
| | - S Crichton
- MRC Clinical Trials Unit at UCLUniversity College London (UCL)LondonUK
| | - T Hill
- Institute for Global HealthUCLLondonUK
| | - K Doerholt
- St George’s University Hospitals NHS Foundation TrustLondonUK
| | - C Foster
- Imperial College Healthcare NHS TrustLondonUK
| | - H Lyall
- Imperial College Healthcare NHS TrustLondonUK
| | - FA Post
- King’s College Hospital NHS Foundation TrustLondonUK
| | - S Welch
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | | | - CA Sabin
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood‐Borne and Sexually Transmitted InfectionsUCL in partnership with Public Health EnglandLondonUK
- Institute for Global HealthUCLLondonUK
| | - A Judd
- MRC Clinical Trials Unit at UCLUniversity College London (UCL)LondonUK
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14
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Asady E, Ghanima W, Jelsness‐Jorgensen L, Klok FA, Kahn SR, Stromme H, Wik HS. Health-related quality-of-life questionnaires for deep vein thrombosis and pulmonary embolism: A systematic review on questionnaire development and methodology. Res Pract Thromb Haemost 2021; 5:e12556. [PMID: 34278190 PMCID: PMC8279125 DOI: 10.1002/rth2.12556] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/19/2021] [Accepted: 05/04/2021] [Indexed: 12/25/2022] Open
Abstract
To improve the quality and accuracy of the patient-reported outcome measures that assess health-related quality of life (HRQoL), guidelines have been developed to standardize the development and validation process. Considering the increasing importance of HRQoL questionnaires in research, we set out to review the literature and evaluate whether existing questionnaires developed for deep vein thrombosis (DVT) and pulmonary embolism (PE) fulfill state-of-the-art requirements. The literature search was conducted in March 2019 and updated in September 2020. Seven databases were searched. No time limit was set for the search to include all available questionnaires. The inclusion criteria were original publications describing the development of disease-specific HRQoL questionnaires specific to DVT or PE in adults and available in English. The questionnaires were assessed to determine whether they fulfill the requirements in the latest guidelines. A total of 3826 references were identified. After the exclusion process, 15 papers were reviewed in full, of which 7 were included. Four questionnaires were developed for chronic venous disease, two were specific to DVT, and one was specific to PE. Most questionnaires we found in this review, fulfilled some but none fulfilled all recommendations in existing guidelines. Because the development of current available HRQoL questionnaires specific to DVT or PE do not fulfil all recommendations of existing guidelines, there is room for improvements within this field. Such improvements could likely enhance the quality associated with the use of these end points in clinical trials and practice.
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Affiliation(s)
- Elia Asady
- Department of ResearchØstfold Hospital TrustGrålumNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Waleed Ghanima
- Department of ResearchØstfold Hospital TrustGrålumNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
- Department of HaematologyOslo University HospitalOsloNorway
| | - Lars‐Petter Jelsness‐Jorgensen
- Department of ResearchØstfold Hospital TrustGrålumNorway
- Department of Health SciencesØstfold University CollegeHaldenNorway
| | - F. A. Klok
- Department of Medicine – Thrombosis and HemostasisLeiden University Medical CenterLeidenThe Netherlands
| | - Susan R. Kahn
- McGill UniversityMontrealQCCanada
- Jewish General HospitalMontrealQCCanada
| | - Hilde Stromme
- Library of Medicine and ScienceUniversity of OsloNorway
| | - Hilde S. Wik
- Department of HaematologyOslo University HospitalOsloNorway
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15
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Laza‐Briviesca R, Cruz‐Bermúdez A, Nadal E, Insa A, García‐Campelo MDR, Huidobro G, Dómine M, Majem M, Rodríguez‐Abreu D, Martínez‐Martí A, De Castro Carpeño J, Cobo M, López Vivanco G, Del Barco E, Bernabé Caro R, Viñolas N, Barneto Aranda I, Viteri S, Massuti B, Casarrubios M, Sierra‐Rodero B, Tarín C, García‐Grande A, Haymaker C, Wistuba II, Romero A, Franco F, Provencio M. Blood biomarkers associated to complete pathological response on NSCLC patients treated with neoadjuvant chemoimmunotherapy included in NADIM clinical trial. Clin Transl Med 2021; 11:e491. [PMID: 34323406 PMCID: PMC8288017 DOI: 10.1002/ctm2.491] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Immunotherapy is being tested in early-stage non-small cell lung cancer (NSCLC), and achieving higher rates of complete pathological responses (CPR) as compared to standard of care. Early identification of CPR patients has vital clinical implications. In this study, we focused on basal peripheral immune cells and their treatment-related changes to find biomarkers associated to CPR. METHODS Blood from 29 stage IIIA NSCLC patients participating in the NADIM trial (NCT03081689) was collected at diagnosis and post neoadjuvant treatment. More than 400 parameters of peripheral blood mononuclear cells (PBMCs) phenotype and plasma soluble factors were analyzed. RESULTS Neoadjuvant chemoimmunotherapy altered more than 150 immune parameters. At diagnosis, 11 biomarkers associated to CPR were described, with an area under the ROC curve >0.70 and p-value <.05. CPR patients had significantly higher levels of CD4+ PD-1+ cells, NKG2D, and CD56 expression on T CD56 cells, intensity of CD25 expression on CD4+ CD25hi+ cells and CD69 expression on intermediate monocytes; but lower levels of CD3+ CD56- CTLA-4+ cells, CD14++ CD16+ CTLA-4+ cells, CTLA-4 expression on T CD56 cells and lower levels of b-NGF, NT-3, and VEGF-D in plasma compared to non-CPR. Post treatment, CPR patients had significantly higher levels of CD19 expression on B cells, BCMA, 4-1BB, MCSF, and PARC and lower levels of MPIF-1 and Flt-3L in plasma compared to non-CPR. CONCLUSIONS Patients achieving CPR seem to have a distinctive peripheral blood immune status at diagnosis, even showing different immune response to treatment. These results reinforce the different biology behind CPR and non-CPR responses.
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Affiliation(s)
- Raquel Laza‐Briviesca
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Puerta de Hierro‐Segovia de Arana (IDIPHISA)Hospital Universitario Puerta de Hierro‐MajadahondaMadridSpain
- Doctoral SchoolUniversidad Autónoma de MadridMadridSpain
| | - Alberto Cruz‐Bermúdez
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Puerta de Hierro‐Segovia de Arana (IDIPHISA)Hospital Universitario Puerta de Hierro‐MajadahondaMadridSpain
| | - Ernest Nadal
- Institut Català d'Oncologia, L'Hospitalet De LlobregatBarcelonaSpain
| | - Amelia Insa
- Fundación INCLIVAHospital Clínico Universitario de ValenciaValenciaSpain
| | | | | | - Manuel Dómine
- Hospital Universitario Fundación Jiménez DíazMadridSpain
| | | | | | - Alex Martínez‐Martí
- Hospital Universitario e Instituto de Oncología Vall d´Hebron (VHIO)BarcelonaSpain
| | | | - Manuel Cobo
- Hospital Universitario Regional de MálagaMálagaSpain
| | | | | | | | | | | | - Santiago Viteri
- Instituto Oncológico Dr. Rosell, Hospital Universitario Quiron DexeusGrupo QuironSaludBarcelonaSpain
| | | | - Marta Casarrubios
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Puerta de Hierro‐Segovia de Arana (IDIPHISA)Hospital Universitario Puerta de Hierro‐MajadahondaMadridSpain
- Doctoral SchoolUniversidad Autónoma de MadridMadridSpain
| | - Belén Sierra‐Rodero
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Puerta de Hierro‐Segovia de Arana (IDIPHISA)Hospital Universitario Puerta de Hierro‐MajadahondaMadridSpain
- Doctoral SchoolUniversidad Autónoma de MadridMadridSpain
| | - Carlos Tarín
- Bioinformatics UnitInstituto de Investigación Sanitaria Puerta de Hierro‐Segovia de AranaMadridSpain
| | - Aránzazu García‐Grande
- Flow Cytometry Core FacilityInstituto de Investigación Sanitaria Puerta de Hierro‐Segovia de Arana (IDIPHISA)MadridSpain
| | - Cara Haymaker
- Departments of Translational Molecular PathologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Ignacio I. Wistuba
- Departments of Translational Molecular PathologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Atocha Romero
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Puerta de Hierro‐Segovia de Arana (IDIPHISA)Hospital Universitario Puerta de Hierro‐MajadahondaMadridSpain
| | - Fernando Franco
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Puerta de Hierro‐Segovia de Arana (IDIPHISA)Hospital Universitario Puerta de Hierro‐MajadahondaMadridSpain
| | - Mariano Provencio
- Servicio de Oncología Médica, Instituto de Investigación Sanitaria Puerta de Hierro‐Segovia de Arana (IDIPHISA)Hospital Universitario Puerta de Hierro‐MajadahondaMadridSpain
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