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Ou L, Liu S, Wang H, Guo Y, Guan L, Shen L, Luo R, Elder DE, Huang AC, Karakousis G, Miura J, Mitchell T, Schuchter L, Amaravadi R, Flowers A, Mou H, Yi F, Guo W, Ko J, Chen Q, Tian B, Herlyn M, Xu X. Patient-derived melanoma organoid models facilitate the assessment of immunotherapies. EBioMedicine 2023; 92:104614. [PMID: 37229906 PMCID: PMC10277922 DOI: 10.1016/j.ebiom.2023.104614] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Only a minority of melanoma patients experience durable responses to immunotherapies due to inter- and intra-tumoral heterogeneity in melanoma. As a result, there is a pressing need for suitable preclinical models to investigate resistance mechanisms and enhance treatment efficacy. METHODS Here, we report two different methods for generating melanoma patient-derived organoids (MPDOs), one is embedded in collagen gel, and the other is inlaid in Matrigel. MPDOs in Matrigel are used for assessing the therapeutic effects of anti-PD-1 antibodies (αPD-1), autochthonous tumor infiltrating lymphocytes (TILs), and small molecule compounds. MPDOs in collagen gel are used for evaluating the chemotaxis and migratory capacity of TILs. FINDING The MPDOs in collagen gel and Matrigel have similar morphology and immune cell composition to their parental melanoma tissues. MPDOs show inter- and intra-tumoral heterogeneity and contain diverse immune cells such as CD4+, CD8+ T, Treg, CD14+ monocytic, CD15+, and CD11b+ myeloid cells. The tumor microenvironment (TME) in MPDOs is highly immunosuppressive, and the lymphoid and myeloid lineages express similar levels of PD-1, PD-L1, and CTLA-4 as their parental melanoma tissues. Anti-PD-1 antibodies (αPD-1) reinvigorate CD8+ T cells and induce melanoma cell death in the MPDOs. TILs expanded by IL-2 and αPD-1 show significantly lower expression of TIM-3, better migratory capacity and infiltration of autochthonous MPDOs, and more effective killing of melanoma cells than TILs expanded by IL-2 alone or IL-2 with αCD3. A small molecule screen discovers that Navitoclax increases the cytotoxicity of TIL therapy. INTERPRETATION MPDOs may be used to test immune checkpoint inhibitors and cellular and targeted therapies. FUNDING This work was supported by the NIH grants CA114046, CA261608, CA258113, and the Tara Miller Melanoma Foundation.
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Affiliation(s)
- Lingling Ou
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510280, China
| | - Shujing Liu
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Huaishan Wang
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Yeye Guo
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Lei Guan
- Department of Biology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Longbin Shen
- The First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Ruhui Luo
- Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510280, China
| | - David E Elder
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Alexander C Huang
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Giorgos Karakousis
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - John Miura
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Tara Mitchell
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Lynn Schuchter
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ravi Amaravadi
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ahron Flowers
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Haiwei Mou
- The Wistar Institute, Philadelphia, PA, 19104, USA
| | - Fan Yi
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Wei Guo
- Department of Biology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jina Ko
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Qing Chen
- The Wistar Institute, Philadelphia, PA, 19104, USA
| | - Bin Tian
- The Wistar Institute, Philadelphia, PA, 19104, USA
| | | | - Xiaowei Xu
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Goldinger SM, Buder-Bakhaya K, Lo SN, Forschner A, McKean M, Zimmer L, Khoo C, Dummer R, Eroglu Z, Buchbinder EI, Ascierto PA, Gutzmer R, Rozeman EA, Hoeller C, Johnson DB, Gesierich A, Kölblinger P, Bennannoune N, Cohen JV, Kähler KC, Wilson MA, Cebon J, Atkinson V, Smith JL, Michielin O, Long GV, Hassel JC, Weide B, Haydu LE, Schadendorf D, McArthur G, Ott PA, Blank C, Robert C, Sullivan R, Hauschild A, Carlino MS, Garbe C, Davies MA, Menzies AM. Chemotherapy after immune checkpoint inhibitor failure in metastatic melanoma: a retrospective multicentre analysis. Eur J Cancer 2021; 162:22-33. [PMID: 34952480 DOI: 10.1016/j.ejca.2021.11.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 08/23/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Despite remarkably improved outcomes with immune checkpoint inhibition, many patients with metastatic melanoma will eventually require further therapy. Chemotherapy has limited activity when used first-line but can alter the tumour microenvironment and does improve efficacy when used in combination with immunotherapy in lung cancer. Whether chemotherapy after checkpoint inhibitor failure has relevant activity in patients with metastatic melanoma is unknown. METHODS Patients with metastatic melanoma treated with chemotherapy after progression on immunotherapy with checkpoint inhibitors were identified retrospectively from 24 melanoma centres. Objective response rate (ORR), progression-free survival (PFS), overall survival (OS) and safety were examined. RESULTS In total, 463 patients were treated between 2007 and 2017. Fifty-six per cent had received PD-1-based therapy before chemotherapy. Chemotherapy regimens included carboplatin + paclitaxel (32%), dacarbazine (25%), temozolomide (15%), taxanes (9%, nab-paclitaxel 4%), fotemustine (6%) and others (13%). Median duration of therapy was 7.9 weeks (0-108). Responses included 0.4% complete response (CR), 12% partial response (PR), 21% stable disease (SD) and 67% progressive disease (PD). Median PFS was 2.6 months (2.2, 3.0), and median PFS in responders was 8.7 months (6.3, 16.3), respectively. Twelve-month PFS was 12% (95% CI 2-15%). In patients who had received anti-PD-1 before chemotherapy, the ORR was 11%, and median PFS was 2.5 months (2.1, 2.8). The highest activity was achieved with single-agent taxanes (N = 40), with ORR 25% and median PFS 3.9 months (2.1, 6.2). Median OS from chemotherapy start was 7.1 months (6.5, 8.0). Subsequent treatment with checkpoint inhibitors achieved a response rate of 16% with a median PFS of 19.1 months (2.0-43.1 months). No unexpected toxicities were observed. CONCLUSION Chemotherapy has a low response rate and short PFS in patients with metastatic melanoma who have failed checkpoint inhibitor therapy, although activity varied between regimens. Chemotherapy has a limited role in the management of metastatic melanoma.
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Affiliation(s)
- Simone M Goldinger
- University of Zurich, Department of Dermatology, Gloriastrasse 31 Zurich, 8091, Switzerland; Melanoma Institute Australia, The University of Sydney, The Poche Centre, 40 Rocklands Road North Sydney NSW 2060, Australia.
| | - Kristina Buder-Bakhaya
- University Hospital Heidelberg, Department of Dermatology and National Center for Cancer (NCT), Im Neuenheimer Feld 460 Heidelberg, 69120, Germany.
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, The Poche Centre, 40 Rocklands Road North Sydney NSW 2060, Australia.
| | - Andrea Forschner
- University of Tuebingen, Department of Dermatology, Liebermeisterstrasse 25, Tübingen, 72076, Germany.
| | - Meredith McKean
- University of Texas MD Anderson Cancer Center, Department of Melanoma Medical Oncology and Department of Surgical Oncology, 1400 Pressler Street, Houston, TX 77006 USA.
| | - Lisa Zimmer
- University Hospital Essen, Department of Dermatology, Essen & German Cancer Consortium, Partner Site Essen, Germany.
| | - Chloe Khoo
- Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Reinhard Dummer
- University of Zurich, Department of Dermatology, Gloriastrasse 31 Zurich, 8091, Switzerland.
| | - Zeynep Eroglu
- Moffitt Cancer Center, Department of Cutaneous Oncology, 12902 Magnolia Drive, Tampa, FL 33612, USA.
| | | | - Paolo A Ascierto
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Napoli, Italy.
| | - Ralf Gutzmer
- Skin Cancer Center, Department of Dermatology, Mühlenkreiskliniken, Ruhr University Bochum Campus Minden, Germany.
| | - Elisa A Rozeman
- Antoni van Leeuwenhoek Hospital - The Netherlands Cancer Institute, Department of Medical Oncology and Immunology, Plesmanlaan 121 Amsterdam, 1066 CX, the Netherlands.
| | - Christoph Hoeller
- Medical University of Vienna, Department of Dermatology, Waehringer Guertel 18-20, Vienna, 1090, Austria.
| | - Douglas B Johnson
- Vanderbilt University Medical Center, Department of Medicine, Nashville, TN, USA.
| | - Anja Gesierich
- University Hospital Wuerzburg, Department of Dermatology, Wuerzburg, Germany.
| | - Peter Kölblinger
- Department of Dermatology and Allergology, Paracelsus Medical University, Salzburg, Austria.
| | - Naima Bennannoune
- Gustave Roussy and Paris-Saclay University, 114 rue Edouard Vaillant Villejuif Cedex, 94805, France.
| | - Justine V Cohen
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
| | - Katharina C Kähler
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Strasse 3, Haus C, Kiel, 24105, Germany.
| | - Melissa A Wilson
- Perlmutter Cancer Center, NYU Langone Health, NYU School of Medicine, 160 E. 34th Street, New York, NY 10016, USA.
| | - Jonathan Cebon
- Olivia Newton-John Cancer Research Institute, Austin Health, School of Cancer Medicine, La Trobe University, 145 Studley Road, Heidelberg VIC, Melbourne, 3084, Australia.
| | - Victoria Atkinson
- University of QLD, Princess Alexandra Hospital, Greenslopes Private Hospital, 199 Ipswich Rd, Woolloongabba QLD 4102, Australia.
| | - Jessica L Smith
- Crown Princess Mary Cancer Centre Westmead, Sydney, NSW, Australia.
| | - Olivier Michielin
- Lausanne University Hospital, Department of Oncology, Precision Oncology Center, Rue du Bugnon 21, Lausanne, 1011, Switzerland.
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, The Poche Centre, 40 Rocklands Road North Sydney NSW 2060, Australia; Royal North Shore Hospital, Reserve Road St Leonards NSW 2065, Australia; Mater Hospital, 25 Rocklands Road, North Sydney NSW 2060, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Charles Perkins Centre, The University of Sydney, Australia.
| | - Jessica C Hassel
- University Hospital Heidelberg, Department of Dermatology and National Center for Cancer (NCT), Im Neuenheimer Feld 460 Heidelberg, 69120, Germany.
| | - Benjamin Weide
- University of Tuebingen, Department of Dermatology, Liebermeisterstrasse 25, Tübingen, 72076, Germany.
| | - Lauren E Haydu
- University of Texas MD Anderson Cancer Center, Department of Melanoma Medical Oncology and Department of Surgical Oncology, 1400 Pressler Street, Houston, TX 77006 USA.
| | - Dirk Schadendorf
- University Hospital Essen, Department of Dermatology, Essen & German Cancer Consortium, Partner Site Essen, Germany.
| | | | - Patrick A Ott
- Dana Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA.
| | - Christian Blank
- Antoni van Leeuwenhoek Hospital - The Netherlands Cancer Institute, Department of Medical Oncology and Immunology, Plesmanlaan 121 Amsterdam, 1066 CX, the Netherlands.
| | - Caroline Robert
- Gustave Roussy and Paris-Saclay University, 114 rue Edouard Vaillant Villejuif Cedex, 94805, France.
| | - Ryan Sullivan
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Strasse 3, Haus C, Kiel, 24105, Germany.
| | - Matteo S Carlino
- Crown Princess Mary Cancer Centre Westmead, Sydney, NSW, Australia.
| | - Claus Garbe
- University of Tuebingen, Department of Dermatology, Liebermeisterstrasse 25, Tübingen, 72076, Germany.
| | - Michael A Davies
- University of Texas MD Anderson Cancer Center, Department of Melanoma Medical Oncology and Department of Surgical Oncology, 1400 Pressler Street, Houston, TX 77006 USA.
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, The Poche Centre, 40 Rocklands Road North Sydney NSW 2060, Australia; Royal North Shore Hospital, Reserve Road St Leonards NSW 2065, Australia; Mater Hospital, 25 Rocklands Road, North Sydney NSW 2060, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
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Tomita A. [Advances in antibody therapy for B cell lymphoma]. Rinsho Ketsueki 2020; 61:901-911. [PMID: 32908054 DOI: 10.11406/rinketsu.61.901] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Almost 20 years have passed after rituximab, an anti-CD20 mouse-human chimeric monoclonal antibody therapeutic, was introduced in the clinical setting for the treatment of CD20-positive B cell malignancies. Although the prognosis has significantly improved in most B cell malignancies, resistance to rituximab with/without chemotherapies is also widely recognized. With this background, newer generation antibody therapeutics and other molecular targeting drugs that show more effectiveness especially to refractory patients are critically required. In this review, molecular mechanisms of the second/third generation anti-CD20 antibodies (ofatumumab and obinutuzumab), anti-CD19 chimeric antigen-receptor T-cells (CAR-T-CD19; tisagenlecleucel, axicabtagene ciloleucel), and the anti-PD-1 antibodies (nivolumab and pembrolizumab) are presented. The therapeutic effectiveness of those drugs as monotherapy and/or combined therapy with conventional chemotherapy (immunochemotherapy) and another molecular targeting therapeutics (so-called "chemo-free" regimens) are also reviewed.
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Affiliation(s)
- Akihiro Tomita
- Department of Hematology, Fujita Health University School of Medicine
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Frelau A, Palard-Novello X, Jali E, Boussemart L, Dupuy A, James P, Devillers A, Le Jeune F, Edeline J, Lesimple T, Girard A. Increased thyroid uptake on 18F-FDG PET/CT is associated with the development of permanent hypothyroidism in stage IV melanoma patients treated with anti-PD-1 antibodies. Cancer Immunol Immunother 2021; 70:679-87. [PMID: 32880684 DOI: 10.1007/s00262-020-02712-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine performances of 2-deoxy-2-(18F)fluoro-D-glucose (18F-FDG) positron emission tomography (PET) to detect the development of permanent thyroid dysfunction (PTD), and to evaluate the prognostic value of early increased thyroid uptake in stage IV melanoma patients treated with anti-programmed death 1 (anti-PD-1) antibodies. METHODS Twenty-nine patients were retrospectively enrolled. PTD was defined as symptomatic thyroid disorder requiring long-term specific treatment. On the first PET performed during follow-up, maximal standardized uptake value of the thyroid (SUVmax-Th) and SUVmax-Th/SUVmax-blood-pool ratio (Th/B) were measured. Areas under ROC curves (AUC) of these parameters for the diagnostic of PTD were compared. Cutoff values were defined to maximize the Youden's index. Survival analyses were performed according to the Kaplan-Meier method and compared using the log-rank method between patients with and without enhanced thyroid uptake according to cutoff values defined with the Hothorn and Lausen method. RESULTS Four patients presented PTD. Median SUVmax-Th and Th/B were, respectively, 2.11 and 1.00. The median follow-up period was 21.7 months. AUC were 1.0 (CI95% 0.88-1.0) for both parameters. Optimal cutoff values were, respectively, SUVmax-Th > 4.1 and Th/B > 2.0, both conferring sensitivities of 100% (CI95% 40-100%) and specificities of 100% (CI95% 86-100%). The median progression-free survival and overall survival were 11.3 months and 33.5 months, respectively. Using optimized cutoffs, there was no statistically significant difference of survival. CONCLUSION SUVmax-Th > 4.1 and Th/B > 2.0 provided perfect diagnostic performances to detect patients that developed PTD. No significant survival difference was found between patients with and without increased thyroid uptake.
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Wang PF, Chen Y, Song SY, Wang TJ, Ji WJ, Li SW, Liu N, Yan CX. Immune-Related Adverse Events Associated with Anti-PD-1/PD-L1 Treatment for Malignancies: A Meta-Analysis. Front Pharmacol 2017; 8:730. [PMID: 29093678 PMCID: PMC5651530 DOI: 10.3389/fphar.2017.00730] [Citation(s) in RCA: 303] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 09/28/2017] [Indexed: 12/12/2022] Open
Abstract
Background: Treatment of cancers with programmed cell death protein 1 (PD-1) pathway inhibitors can lead to immune-related adverse events (irAEs), which could be serious and even fetal. Therefore, clinicians should be aware of the characteristics of irAEs associated with the use of such drugs. Methods: The MEDLINE, EMBASE, and Cochrane databases were searched to find potential studies using the following strategies: anti-PD-1/PD-L1 treatment; irAEs; and cancer. R© package Meta was used to pool incidence. Results: Forty-six studies representing 12,808 oncologic patients treated with anti-PD-1/PD-L1 agents were included in the meta-analysis. The anti-PD-1/PD-L1 agents included nivolumab, pembrolizumab, atezolizumab, durvalumab, avelumab, and BMS-936559. The tumor types were melanomas, Hodgkin lymphomas, urothelial carcinomas, breast cancers, non-small cell lung cancers, renal cell carcinomas (RCC), colorectal cancers, and others. We described irAEs according to organ systems, namely, the skin (pruritus, rash, maculopapular rash, vitiligo, and dermatitis), endocrine system (hypothyroidism, hyperthyroidism, hypophysitis, thyroiditis, and adrenal insufficiency), digestive system (colitis, diarrhea, pancreatitis, and increased AST/ALT/bilirubin), respiratory system (pneumonitis, lung infiltration, and interstitial lung disease), and urinary system (increased creatinine, nephritis, and renal failure). In patients treated with the PD-1 signaling inhibitors, the overall incidence of irAEs was 26.82% (95% CI, 21.73-32.61; I2, 92.80) in any grade and 6.10% (95% CI, 4.85-7.64; I2, 52.00) in severe grade, respectively. The development of irAEs was unrelated to the dose of anti-PD-1/PD-L1 agents. The incidence of particular irAEs varied when different cancers were treated with different drugs. The incidence of death due to irAEs was around 0.17%. Conclusion: The occurrence of irAEs was organ-specific and related to drug and tumor types.
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Affiliation(s)
- Peng-Fei Wang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yang Chen
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Si-Ying Song
- Department of Clinical Medicine, Capital Medical University, Beijing, China
| | - Ting-Jian Wang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Wen-Jun Ji
- Key Laboratory, Department of Neurosurgery, The Second Hospital of Yulin, Xi'an Jiaotong University, Xi'an, China
| | - Shou-Wei Li
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Ning Liu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Chang-Xiang Yan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
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Bersanelli M, Buti S. From targeting the tumor to targeting the immune system: Transversal challenges in oncology with the inhibition of the PD-1/PD-L1 axis. World J Clin Oncol 2017; 8:37-53. [PMID: 28246584 PMCID: PMC5309713 DOI: 10.5306/wjco.v8.i1.37] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/09/2016] [Accepted: 11/27/2016] [Indexed: 02/06/2023] Open
Abstract
After that the era of chemotherapy in the treatment of solid tumors have been overcome by the "translational era", with the innovation introduced by targeted therapies, medical oncology is currently looking at the dawn of a new "immunotherapy era" with the advent of immune checkpoint inhibitors (CKI) antibodies. The onset of PD-1/PD-L1 targeted therapy has demonstrated the importance of this axis in the immune escape across almost all human cancers. The new CKI allowed to significantly prolong survival and to generate durable response, demonstrating remarkable efficacy in a wide range of cancer types. The aim of this article is to review the most up to date literature about the clinical effectiveness of CKI antibodies targeting PD-1/PD-L1 axis for the treatment of advanced solid tumors and to explore transversal challenges in the immune checkpoint blockade.
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Simeone E, Grimaldi AM, Festino L, Giannarelli D, Vanella V, Palla M, Curvietto M, Esposito A, Palmieri G, Mozzillo N, Ascierto PA. Correlation between previous treatment with BRAF inhibitors and clinical response to pembrolizumab in patients with advanced melanoma. Oncoimmunology 2017; 6:e1283462. [PMID: 28405510 PMCID: PMC5384373 DOI: 10.1080/2162402x.2017.1283462] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/10/2017] [Accepted: 01/12/2017] [Indexed: 10/20/2022] Open
Abstract
The optimal sequencing of targeted treatment and immunotherapy in the treatment of advanced melanoma is a key question and prospective studies to address this are ongoing. Previous observations suggest that treating first with targeted therapy may select for more aggressive disease, meaning that patients may not gain full benefit from subsequent immunotherapy. In a single-center retrospective analysis, we investigated whether response to pembrolizumab was affected by previous BRAF inhibitor therapy. A total of 42 patients with metastatic cutaneous or mucosal melanoma who had received previous treatment with ipilimumab were treated with pembrolizumab as part of the Italian expanded access program. Sixteen of these patients had BRAF-mutated melanoma and had also been previously treated with a BRAF inhibitor (vemurafenib or dabrafenib), while 26 had BRAF wild-type melanoma (no previous BRAF inhibitor). Patients with BRAF-mutant melanoma who were previously treated with BRAF inhibitors had a significantly lower median progression-free survival (3 [2.3-3.7] versus not reached [2-8+] mo; p = 0.001) and disease control rate (18.6% versus 65.4%; p = 0.005) than patients with BRAF wild-type, while there was also a trend toward a lower response rate (assessed using immune-related response criteria) although this was not significantly different between groups (12.5% versus 36.4%; p = 0.16). These data are consistent with previous reports that BRAF inhibitor therapy may affect subsequent response to immunotherapy.
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Affiliation(s)
- Ester Simeone
- Melanoma, Cancer Immunotherapy and Innovative Therapies O.U., Istituto Nazionale Tumori Fondazione “G. Pascale”, Napoli, Italy
| | - Antonio Maria Grimaldi
- Melanoma, Cancer Immunotherapy and Innovative Therapies O.U., Istituto Nazionale Tumori Fondazione “G. Pascale”, Napoli, Italy
| | - Lucia Festino
- Melanoma, Cancer Immunotherapy and Innovative Therapies O.U., Istituto Nazionale Tumori Fondazione “G. Pascale”, Napoli, Italy
| | | | - Vito Vanella
- Melanoma, Cancer Immunotherapy and Innovative Therapies O.U., Istituto Nazionale Tumori Fondazione “G. Pascale”, Napoli, Italy
| | - Marco Palla
- Melanoma, Cancer Immunotherapy and Innovative Therapies O.U., Istituto Nazionale Tumori Fondazione “G. Pascale”, Napoli, Italy
| | - Marcello Curvietto
- Melanoma, Cancer Immunotherapy and Innovative Therapies O.U., Istituto Nazionale Tumori Fondazione “G. Pascale”, Napoli, Italy
| | - Assunta Esposito
- Melanoma, Cancer Immunotherapy and Innovative Therapies O.U., Istituto Nazionale Tumori Fondazione “G. Pascale”, Napoli, Italy
| | - Giuseppe Palmieri
- Unit of Melanoma and Sarcoma Surgery, Istituto Nazionale Tumori Fondazione, Napoli, Italy
| | - Nicola Mozzillo
- Unit of Melanoma and Sarcoma Surgery, Istituto Nazionale Tumori Fondazione, Napoli, Italy
| | - Paolo Antonio Ascierto
- Melanoma, Cancer Immunotherapy and Innovative Therapies O.U., Istituto Nazionale Tumori Fondazione “G. Pascale”, Napoli, Italy
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