26
|
Mallardo D, Grimaldi AM, Capone M, Bayless N, Madonna G, Festino L, Vitale MG, Trojaniello C, Vanella V, Curvietto M, Esposito A, Palla M, Scarpato L, Cavalcanti E, Caraco C, Ong S, Warren S, Cesano A, Ascierto PA, Simeone E. Identification of potential predictive biomarkers of rapid progression and rapid response to anti-PD1 treatment by gene profiling analysis in metastatic melanoma patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e22068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22068 Background: Anti-PD-1 agents represent a standard treatment for melanoma patients. However, most patients fail to respond, showing in some cases very rapid disease progression. At moment, there are no effective biomarkers that can predict patient's clinical benefit. The aim of this study is to retrospectively identify gene profiling biomarkers that could help to select melanoma patients who most likely respond to anti-PD-1 therapy. Methods: We defined as fast responder (FR) or fast progressor (FP) patients who got clinical response or clinical progression after two cycles of therapy. We collected data from 44 metastatic melanoma patients (21 FR and 23 FP) treated in first-line with anti-PD1 monotherapy (nivolumab or pembrolizumab) at National Cancer Institute of Naples, Italy. Gene expression profiling analysis was performed using NanoString IO 360 panels on PBMCs collected at baseline from 18 patients (10 FR and 8 FP). Patients with ECOG≥2 were excluded. They were all IV stage (5 M1a, 1 M1b, 12 M1c) of which 15 were B-RAF wild-type (83%) and 3 were B-RAF mutated (17%). Statistical associations between treatment response and gene score variables were estimated by Student’s T tests and correction for multiple comparisons by the Benjamini-Hochberg method. Results: Patterns of gene expression were assessed for correlation to response. We compared PBMCs nanostring analysis between FR and FP patients. We found a higher expression of KRas, CD39, IFI16, IL18, FCGR2A, IL1RN, MAP3K8, TLR5, TLR8, MyD88 and NF-kB in FP patients (all with p-value ≤0.005), most of them related to cell proliferation and immunosuppressive mechanism. Instead we found a higher expression of PRF1, PIK3R1, HLA-DPA1, HLA-DRB1, HLA-DOA, CD45RA, LDHB, KIR3DL2, CD2, CD28, CD7, CD27 in FR patients (all with p-value ≤0.01), most of them related to priming and cytolysis. Conclusions: These preliminary data obtained through gene profiling analysis on baseline PBMCs of melanoma patients suggest that a specific gene signature may discriminate FR or FP patients. Our study provides rationale for further investigating gene profiling signature as a potential association for response to immunotherapy.
Collapse
|
27
|
Simeone E, Mallardo D, Giannarelli D, Festino L, Vanella V, Trojaniello C, Vitale MG, Palla M, Scarpato L, Capone M, Madonna G, Curvietto M, Esposito A, Hauber F, Sandomenico F, Cavalcanti E, Caraco C, Mainardi P, Grimaldi AM, Ascierto PA. Correlation of nivolumab 480 mg Q4W with better survival than other nivolumab monotherapy schedule in metastatic melanoma patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e22008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22008 Background: Nivolumab (nivo) 480 mg (Q4W) flat dose has already been assessed for safety compared to other drug dose regimens in clinical trials [1]. However, few data about melanoma patients treated in real life are available. The aim of our study was to evaluate safety and efficacy in metastatic melanoma pts treated with different schedules of nivo in clinical practice. Methods: We analyzed data from n.124 metastatic melanoma patients who were treated from Jun 2016 to Oct 2019 at NCI of Naples. 83/ 124 (67%) were treated with nivo 480 mg Q4W, and 41/124 (33%) with other schedules (n.26 [63%] with 3 mg/kg, and 15 [37%] with 240 mg Q2W). All patients were stage IV, and n.44/124 (35%) were B-RAF mutated. Nivo was administered as first line in n.95 patients (77%), n. 24 [19%] as second line, and 5 (4%) as third line. Among B-RAF mutated patients, n.23/44 [52%] received a first line with a target-based regimen. According to our previous work [2] we calculated Body Mass Index (BMI). In 93/124 pts the BMI was < 25 (75%), while in 31/124 (25%) BMI was ≥ 25. In the table are summarized other clinical characteristics. Hazard Ratios and their 95% confidence intervals (95% CI) were estimated with the Cox model. Association between factors was evaluated with the chi-square test. Results: Our data suggests that nivo 480 mg (Q4W) correlates with a better OS compared with other regimens (HR = 0.48; [95% CI: 0.24-0.96; p = 0.04]). Moreover, better OS trend was also observed in pts with BMI > 25 (HR = 0.48; [95% CI: 0.33-1.74]; p = 0.51) and with B-RAF mutation (HR = 0.53; [95% CI: 0.25-1.14); P = 0.10]). The incidence of any grade toxicities did not differ according the dosage. Conclusions: This retrospective analysis showed a trend of better outcome with nivo 480. This observation warrants further investigation in a larger cohort of pts. [Table: see text]
Collapse
|
28
|
Coutzac C, Jouniaux JM, Paci A, Schmidt J, Mallardo D, Seck A, Asvatourian V, Cassard L, Saulnier P, Lacroix L, Woerther PL, Vozy A, Naigeon M, Nebot-Bral L, Desbois M, Simeone E, Mateus C, Boselli L, Grivel J, Soularue E, Lepage P, Carbonnel F, Ascierto PA, Robert C, Chaput N. Systemic short chain fatty acids limit antitumor effect of CTLA-4 blockade in hosts with cancer. Nat Commun 2020; 11:2168. [PMID: 32358520 PMCID: PMC7195489 DOI: 10.1038/s41467-020-16079-x] [Citation(s) in RCA: 238] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/08/2020] [Indexed: 12/19/2022] Open
Abstract
Gut microbiota composition influences the clinical benefit of immune checkpoints in patients with advanced cancer but mechanisms underlying this relationship remain unclear. Molecular mechanism whereby gut microbiota influences immune responses is mainly assigned to gut microbial metabolites. Short-chain fatty acids (SCFA) are produced in large amounts in the colon through bacterial fermentation of dietary fiber. We evaluate in mice and in patients treated with anti-CTLA-4 blocking mAbs whether SCFA levels is related to clinical outcome. High blood butyrate and propionate levels are associated with resistance to CTLA-4 blockade and higher proportion of Treg cells. In mice, butyrate restrains anti-CTLA-4-induced up-regulation of CD80/CD86 on dendritic cells and ICOS on T cells, accumulation of tumor-specific T cells and memory T cells. In patients, high blood butyrate levels moderate ipilimumab-induced accumulation of memory and ICOS + CD4 + T cells and IL-2 impregnation. Altogether, these results suggest that SCFA limits anti-CTLA-4 activity. The gut microbiota has been reported to regulate the efficacy of cancer therapy. Here, the authors show that short-chain fatty acids, which are generated through bacterial fermentation, increases immune tolerance leading to resistance to anti-CTLA-4 immunotherapy in mice and patients with metastatic melanoma.
Collapse
|
29
|
Simeone E, Grimaldi AM, Festino L, Trojaniello C, Vitale MG, Vanella V, Palla M, Ascierto PA. Immunotherapy in metastatic melanoma: a novel scenario of new toxicities and their management. Melanoma Manag 2019; 6:MMT30. [PMID: 31871619 PMCID: PMC6920742 DOI: 10.2217/mmt-2019-0005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Checkpoint inhibitors can cause an imbalance in immune tolerance that may clinically manifest as immune-related adverse events (irAEs). These events may involve many organs and tissues, including the skin, gastrointestinal (GI) tract, liver, endocrine system, kidneys, central nervous system (CNS), eyes and lungs. The incidence of irAEs appears to be lower with anti-programmed death antigen-1/programmed death antigen-ligand-1 agents than with the anti-cytotoxic T-lymphocyte-associated protein-4 antibody ipilimumab. Combined immunotherapy does not appear to be associated with novel safety signals compared with monotherapy, but more organs may be involved. Increased experience and the use of algorithms for the most common irAEs have resulted in severe toxicity and related deaths being reduced. However, continuous vigilance, especially regarding less common events, is needed to better characterize the wide spectrum of clinical manifestations.
Collapse
|
30
|
Simeone E, Grimaldi AM, Festino L, Trojaniello C, Vitale MG, Vanella V, Curvietto M, Ascierto PA. Nivolumab for the treatment of small cell lung cancer. Expert Rev Respir Med 2019; 14:5-13. [PMID: 31622114 DOI: 10.1080/17476348.2020.1681977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Treatment of extensive-stage SCLC is still a challenge but immunotherapy with checkpoint inhibitors is showing promising results. Nivolumab alone or in combination with ipilimumab has demonstrated a benefit in terms of response and survival in patients with pre-treated extensive-stage disease and has been approved as third-line therapy after failure of chemotherapy. However, data from two phase III trials with nivolumab are negative. In the first trial, nivolumab was administered as a single agent compared to second-line chemotherapy, while in the second it was given alone or in combination with ipilimumab as maintenance treatment after platinum-based chemotherapy.Areas covered: Our review focuses on the role of immunotherapy, and in particular nivolumab, in the treatment of SCLC, describing the results of the main trials and its future perspectives, with reference to clinical trials with other checkpoint inhibitors.Expert opinion: The future of nivolumab in the treatment of SCLC needs to be clarified with further clinical trials, in which improved patient selection and a more specific setting and/or timepoint of the disease may be identified.
Collapse
|
31
|
Ascierto PA, Capone M, Grimaldi AM, Mallardo D, Simeone E, Madonna G, Roder H, Meyer K, Asmellash S, Oliveira C, Roder J, Grigorieva J. Proteomic test for anti-PD-1 checkpoint blockade treatment of metastatic melanoma with and without BRAF mutations. J Immunother Cancer 2019; 7:91. [PMID: 30925943 PMCID: PMC6440152 DOI: 10.1186/s40425-019-0569-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 03/15/2019] [Indexed: 11/28/2022] Open
Abstract
The therapeutic landscape in metastatic melanoma has changed dramatically in the last decade, with the success of immune checkpoint inhibitors resulting in durable responses for a large number of patients. For patients with BRAF mutations, combinations of BRAF and MEK inhibitors demonstrated response rates and benefit comparable to those from immune checkpoint inhibitors, providing the rationale for sequential treatment with targeted and immunotherapies and raising the question of optimal treatment sequencing. Biomarkers for the selection of anti-PD-1 therapy in BRAF wild type (BRAF WT) and in BRAF mutated (BRAF MUT) patients help development of alternative treatments for patients unlikely to benefit, and might lead to better understanding of the interaction of checkpoint inhibition and targeted therapy. In this paper we evaluate the performance of a previously developed serum proteomic test, BDX008, in metastatic melanoma patients treated with anti-PD-1 agents and investigate the role of BRAF mutation status. BDX008, a pre-treatment proteomic test associated with acute phase reactants, wound healing and complement activation, stratifies patients into two groups, BDX008+ and BDX008-, with better and worse outcomes on immunotherapy. Serum samples were available from 71 patients treated with anti-PD1 inhibitors; 25 patients had BRAF mutations, 39 were wild type. Overall, BDX008+ patients had significantly better overall survival (OS) (HR = 0.50, P = 0.016) and a trend for better progression-free survival (PFS) (HR = 0.61, P = 0.060) than BDX008- patients. BDX008 classification was statistically significant in the analyses adjusted for mutation status, LDH, and line of treatment (P = 0.009 for OS and 0.031 for PFS). BRAF WT BDX008+ patients had markedly long median OS of 32.5 months and 53% landmark 2 years survival, with statistically significantly superior OS as compared to BDX008- patients (HR = 0.41, P = 0.032). The difference between BDX008+ and BDX008- in PFS in BRAF WT patients and in OS and PFS in BRAF MUT patients did not reach statistical significance, though numerically was consistent with overall results. The test demonstrated significant interaction with neutrophil-to-lymphocyte ratio (NLR) (PFS P = 0.041, OS P = 0.004). BDX008 as a biomarker selecting for benefit from immune checkpoint blockade, especially in patients with wild type BRAF and in subgroups with low NLR, warrants further evaluation.
Collapse
|
32
|
Pistillo MP, Fontana V, Morabito A, Dozin B, Laurent S, Carosio R, Banelli B, Ferrero F, Spano L, Tanda E, Ferrucci PF, Martinoli C, Cocorocchio E, Guida M, Tommasi S, De Galitiis F, Pagani E, Antonini Cappellini GC, Marchetti P, Quaglino P, Fava P, Osella-Abate S, Ascierto PA, Capone M, Simeone E, Romani M, Spagnolo F, Queirolo P. Soluble CTLA-4 as a favorable predictive biomarker in metastatic melanoma patients treated with ipilimumab: an Italian melanoma intergroup study. Cancer Immunol Immunother 2019; 68:97-107. [PMID: 30311027 PMCID: PMC11028053 DOI: 10.1007/s00262-018-2258-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 10/04/2018] [Indexed: 12/11/2022]
Abstract
CTLA-4 blockade by means of ipilimumab (IPI) potentiates the immune response and improves overall survival (OS) in a minority of metastatic melanoma (MM) patients. We investigated the role of soluble CTLA-4 (sCTLA-4) as a possible biomarker for identifying this subset of patients. sCTLA-4 levels were analyzed at baseline in sera from 113 IPI-treated MM patients by ELISA, and the median value (200 pg/ml) was used to create two equally sized subgroups. Associations of sCTLA-4 with best overall response (BOR) to IPI and immune-related adverse events (irAEs) were evaluated through logistic regression. Kaplan-Meier and Cox regression methods were used to analyze OS. A remarkable association between sCTLA-4 levels and BOR was found. Specifically, the proportion of patients with sCTLA-4 > 200 pg/ml in irSD or irPD (immune-related stable or progressive disease) was, respectively, 80% (OR = 0.23; 95%CL = 0.03-1.88) and 89% (OR = 0.11; 95%CL = 0.02-0.71) and was lower than that observed among patients in irCR/irPR (immune-related complete/partial response). sCTLA-4 levels increased during IPI treatment, since the proportion of patients showing sCTLA > 200 pg/ml after 3 cycles was 4 times higher (OR = 4.41, 95%CL = 1.02-19.1) than that after 1 cycle. Moreover, a significantly lower death rate was estimated for patients with sCTLA-4 > 200 pg/ml (HR = 0.61, 95%CL = 0.39-0.98). Higher baseline sCTLA-4 levels were also associated with the onset of any irAE (p value = 0.029), in particular irAEs of the digestive tract (p value = 0.041). In conclusion, our results suggest that high sCTLA-4 serum levels might predict favorable clinical outcome and higher risk of irAEs in IPI-treated MM patients.
Collapse
|
33
|
Madonna G, Ballesteros-Merino C, Feng Z, Bifulco C, Capone M, Giannarelli D, Mallardo D, Simeone E, Grimaldi AM, Caracò C, Botti G, Fox BA, Ascierto PA. PD-L1 expression with immune-infiltrate evaluation and outcome prediction in melanoma patients treated with ipilimumab. Oncoimmunology 2018; 7:e1405206. [PMID: 30524879 DOI: 10.1080/2162402x.2017.1405206] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 10/26/2017] [Accepted: 11/06/2017] [Indexed: 12/31/2022] Open
Abstract
Background: Tumor microenvironment may have a key role in providing immunological markers that can help predict clinical response to treatment with checkpoint inhibitors. We investigated whether the baseline expression of PD-L1 in advanced melanoma patients treated with ipilimumab may correlate with clinical outcome. Methods: PD-L1 expression was assessed in 114 patients with advanced melanoma treated with ipilimumab and, in a cohort of 77 patients, a comprehensive assessment using multispectral imaging to assess the presence and distribution of CD3+, CD8+, CD163+, FOXP3+ and PD-L1+ cells inside and at periphery of the tumor was performed. Results: PD-L1 status alone was not a predictive biomarker for response or survival. There was an association between clinical benefit from ipilimumab therapy with the coexistence of low densities of CD8+ and high densities of CD163+ PD-L1+ cells at the periphery of the tumor. Conclusions: To explain the association of this peculiar microenvironment with clinical benefit from ipilimumab, we proposed a model where baseline CD8 cells levels are low due to inhibitory effect of Tregs and to pro-tumor activity of TAM M2 (CD163+ PD-L1+ cells). Ipilimumab treatment causes a decrease of Treg cells, mediated by ADCC from macrophages, with a concomitant change in TAM polarization that switches from M2 to M1 with a subsequent attraction of CD8 cells and the increase of antitumor response.
Collapse
|
34
|
Capone M, Giannarelli D, Mallardo D, Madonna G, Festino L, Grimaldi AM, Vanella V, Simeone E, Paone M, Palmieri G, Cavalcanti E, Caracò C, Ascierto PA. Baseline neutrophil-to-lymphocyte ratio (NLR) and derived NLR could predict overall survival in patients with advanced melanoma treated with nivolumab. J Immunother Cancer 2018; 6:74. [PMID: 30012216 PMCID: PMC6048712 DOI: 10.1186/s40425-018-0383-1] [Citation(s) in RCA: 299] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies have suggested that elevated neutrophil-to-lymphocyte ratio (NLR) is prognostic for worse outcomes in patients with a variety of solid cancers, including those treated with immune checkpoint inhibitors. Methods This was a retrospective analysis of 97 consecutive patients with stage IV melanoma who were treated with nivolumab. Baseline NLR and derived (d) NLR were calculated and, along with other characteristics, correlated with progression-free survival (PFS) and overall survival (OS) in univariate and multivariate analyses. The best cutoff values for NLR and dNLR were derived using Cutoff Finder software based on an R routine which optimized the significance of the split between Kaplan-Meier survival curves. Results In univariate analysis, increasing absolute neutrophil count (ANC), NLR, dNLR and lactate dehydrogenase (LDH) (continuous variables) were all significantly associated with OS. Only NLR (hazard ratio [HR] = 2.85; 95% CI 1.60–5.08; p < 0.0001) and LDH (HR = 2.51; 95% CI 1.36–4.64; p < 0.0001) maintained a significant association with OS in multivariate analysis. Patients with baseline NLR ≥5 had significantly worse OS and PFS than patients with NLR < 5, as did patients with baseline dNLR ≥3 versus < 3. Optimal cut-off values were ≥ 4.7 for NLR and ≥ 3.8 for dNLR. Using this ≥4.7 cut-off for NLR, the values for OS and PFS were overlapping to the canonical cut-off for values, and dNLR< 3.8 was also associated with better OS and PFS. Conclusion Both Neutrophil-to-lymphocyte ratio (NLR) and derived (d) NLR were associated with improved survival when baseline levels were lower than cut-off values. NLR and dNLR are simple, inexpensive and readily available biomarkers that could be used to help predict response to immunotherapy in patients with advanced melanoma. Electronic supplementary material The online version of this article (10.1186/s40425-018-0383-1) contains supplementary material, which is available to authorized users.
Collapse
|
35
|
Buonaguro L, Mayer-Mokler A, Accolla R, Ma YT, Heidenreich R, Avallone A, Simeone E, Koenigsrainer A, Loeffler M, Gouttefangeas C, Flohr C, Ludwig J, Rammensee HG, Iñarrairaegui M, Francque S, Chaumette T, Weinschenk T, Reinhardt C, Gnad-Vogt SU, Singh H. HepaVac-101 first-in-man therapeutic cancer vaccine phase I/II clinical trial for hepatocellular carcinoma patients. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps3135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
36
|
Queirolo P, Dozin B, Morabito A, Banelli B, Carosio R, Fontana V, Ferrucci PF, Martinoli C, Cocorocchio E, Ascierto PA, Madonna G, Simeone E, De Galitiis F, Antonini Cappellini GC, Marchetti P, Guida M, Tommasi S, Ghilardi L, Merelli B, Fava P, Osella-Abate S, Guidoboni M, Romani M, Ferone D, Spagnolo F, Pistillo MP. CTLA-4 gene variant -1661A>G may predict the onset of endocrine adverse events in metastatic melanoma patients treated with ipilimumab. Eur J Cancer 2018; 97:59-61. [PMID: 29743138 DOI: 10.1016/j.ejca.2018.04.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/05/2018] [Accepted: 04/05/2018] [Indexed: 01/18/2023]
|
37
|
Queirolo P, Dozin B, Morabito A, Banelli B, Piccioli P, Fava C, Leo C, Carosio R, Laurent S, Fontana V, Ferrucci PF, Martinoli C, Cocorocchio E, Battaglia A, Ascierto PA, Capone M, Simeone E, De Galitiis F, Pagani E, Antonini Cappellini GC, Marchetti P, Guida M, Tommasi S, Mandalà M, Merelli B, Quaglino P, Fava P, Guidoboni M, Romani M, Spagnolo F, Pistillo MP. Corrigendum: Association of CTLA-4 Gene Variants with Response to Therapy and Long-term Survival in Metastatic Melanoma Patients Treated with Ipilimumab: An Italian Melanoma Intergroup Study. Front Immunol 2018. [PMID: 29531523 PMCID: PMC5840259 DOI: 10.3389/fimmu.2018.00403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article on p. 386 in vol. 8, PMID: 28446908.].
Collapse
|
38
|
Fratangelo F, Morello S, Madonna G, Capone M, Mallardo D, Falcone R, Grimaldi A, Simeone E, Vanella V, Giannarelli D, Sorrentino C, Pinto A, Ascierto P. Expression of CD73 on MDSCs and CD8+/PD-1+ cells as new possible biomarkers for advanced melanoma patients treated with nivolumab. Eur J Cancer 2018. [DOI: 10.1016/j.ejca.2018.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
39
|
Ferrucci P, Ascierto P, Pigozzo J, Del Vecchio M, Maio M, Antonini Cappellini G, Guidoboni M, Queirolo P, Savoia P, Mandalà M, Simeone E, Valpione S, Altomonte M, Spagnolo F, Cocorocchio E, Gandini S, Giannarelli D, Martinoli C. Baseline neutrophils and derived neutrophil-to-lymphocyte ratio: prognostic relevance in metastatic melanoma patients receiving ipilimumab. Ann Oncol 2018; 29:524. [DOI: 10.1093/annonc/mdx059] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
40
|
Simeone E, Ascierto PA. Anti-PD-1 and PD-L1 antibodies in metastatic melanoma. Melanoma Manag 2017; 4:175-178. [PMID: 30190923 DOI: 10.2217/mmt-2017-0018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/12/2017] [Indexed: 02/01/2023] Open
|
41
|
Vanella V, Festino L, Strudel M, Simeone E, Grimaldi AM, Ascierto PA. PD-L1 inhibitors in the pipeline: Promise and progress. Oncoimmunology 2017; 7:e1365209. [PMID: 29296516 PMCID: PMC5739559 DOI: 10.1080/2162402x.2017.1365209] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 07/28/2017] [Accepted: 08/04/2017] [Indexed: 01/05/2023] Open
Abstract
Checkpoint inhibitors have improved survival for patients with melanoma, non-small-cell lung cancer (NSCLC), bladder, head and neck and other cancers. Antibodies against PD-L1, including atezolizumab, avelumab and durvalumab, are also being developed and have been approved for various cancers. Compared with anti-CTLA-4 drugs, studies with anti-PD-1/PD-L1 agents have suggested higher response rates and improved survival. Targeting PD-L1 rather than PD-1 may also theoretically offer further benefit, with the potential for improved efficacy and reduced toxicity, although this has not been clearly shown by clinical experience to date. Anti-PD-L1 agents have shown good efficacy and manageable toxicity in several tumor types.
Collapse
|
42
|
Romano S, Simeone E, D'Angelillo A, D'Arrigo P, Russo M, Capasso M, Lasorsa VA, Zambrano N, Ascierto PA, Romano MF. FKBP51s signature in peripheral blood mononuclear cells of melanoma patients as a possible predictive factor for immunotherapy. Cancer Immunol Immunother 2017; 66:1143-1151. [PMID: 28434031 PMCID: PMC11028940 DOI: 10.1007/s00262-017-2004-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/16/2017] [Indexed: 12/22/2022]
Abstract
The inhibitory immune checkpoint PD-L1/PD1 promotes the alternative splicing of the FKBP5 gene, resulting in increased expression of its variant 4 in the peripheral blood mononuclear cells of melanoma patients. The variant 4 transcript is translated into the truncated FKBP51s protein. Given the importance of co-inhibitory signalling in tumour immune escape, here we tested the potential for using FKBP51s expression to predict immunotherapy outcomes. To do this, we immunophenotyped PBMCs from 118 melanoma patients and 77 age- and sex-matched healthy controls. Blood samples were collected before patients underwent ipilimumab treatment. In 64 of the 118 patients, FKBP51s expression was also assessed in regulatory T cells (Tregs). We found that each PBMC subset analysed contained an FKBP51spos fraction, and that this fraction was greater in the melanoma patients than healthy controls. In CD4 T lymphocytes, the FKBP51sneg fraction was significantly impaired. Tregs count was increased in melanoma patients, which is in line with previous studies. Also, by analyses of FKBP51s in Tregs, we identified a subgroup of ipilimumab nonresponder patients (p = 0.002). In conclusion, FKBP51s-based immunophenotyping of melanoma patients revealed several profiles related to a negative immune regulatory control and identified an unknown Treg subset. These findings are likely to be useful in the selection of the patients that are candidate for immunotherapy.
Collapse
|
43
|
Romano S, Simeone E, D'Angelillo A, D'Arrigo P, Capasso M, Lasorsa VA, Tufano M, Rea A, Russo M, Zambrano N, Ascierto PA, Romano MF. Abstract 2624: An FKBP5-based immunophenotype for assessment of the immunosuppression status and possible prediction of immunotherapy response in melanoma patients. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-2624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background and aim: FKBP51 is an immunophilin encoded by FKBP5 gene on chromosome 6. It is a protein resident in lymphocytes and involved in immune response. Recently, our group demonstrated that the inhibitory checkpoint PD-L1/PD1 promoted the alternative splicing of FKBP5 gene, resulting in increased expression of its variant 4, in PBMC of melanoma patients. The aim of this study was to address whether such a molecular signature could help in identifying an immune profile associated with increased probability of immunotherapy response.
Experimental Design: The splicing FKBP51 isoform or FKBP51s was measured in peripheral blood T lymphocytes subsets (CD3/CD4, CD3/CD8, CD25 and PD-L1) and CD14 monocytes from a cohort of 118 patients and 77 age- and sex-matched healthy controls, by flow cytometry. Blood samples were collected before patients underwent ipilimumab treatment. Furthermore, in 64 out of 118 patients, expression of FKBP51s was also assessed in regulatory T cells.
Results: Physiologically, each PBMC subset analyzed contained a fraction of an FKBP51spos component, which resulted expanded in melanoma patients. We also measured an increase in CD3/CD8 and PD-L1 lymphocytes in patients. CD4 T lymphocytes showed the FKBP51sneg fraction significantly impaired, which might reflect the condition of impaired T cell help. Treg count was increased, in accordance with previous studies. The count of FKBP51sposTregs defined a subgroup of nonresponder patients to ipilimumab, by 92.6%. A 2D hierarchical partitioning of data from FKBP51s-immunophenotype (heatmap) revealed 3 main clusters: C1 (33 pts, 51,5%), C2 (14 pts, 22%) and C3 (17 pts, 26,5%). FKBP51spos Treg subset appeared globally increased in all clusters. In C1, values of effector T cells and monocytes were not different from normal donors. C2 showed a significant increase of FKBP51spos PD-L1 monocytes and a significant probability of not responding (Chi-square=5.46; p=0.019). This finding is consistent with the hypothesis that response to ipilimumab is prevented by accessory cells exerting a negative immune regulatory control. C3 showed a significant increase of FKBP51s in overall lymphocyte subsets analyzed. Patients in this cluster showed reduced overall survival. This finding suggests that a prevalence of activation (CD25) and co-inhibitory (PD-L1) markers together with the expansion of FKBP51spos effector T cells might reflect a condition of chronic lymphocyte stimulation in some advanced melanoma patients, contributing to T cell-exhaustion.
Conclusions: FKBP51s-based immunophenotype of melanoma patients revealed several profiles virtually related to a negative immune regulatory control and highlights an impairment of a Treg subset endowed with increased suppressive potential. Such FKBP51sTreg subset is likely to be associated with immunotherapy response (Chi-square=9.916, p=0.002) .
Citation Format: Simona Romano, Ester Simeone, Anna D'Angelillo, Paolo D'Arrigo, Mario Capasso, Vito Alessandro Lasorsa, Martina Tufano, Anna Rea, Michele Russo, Nicola Zambrano, Paolo Antonio Ascierto, Maria Fiammetta Romano. An FKBP5-based immunophenotype for assessment of the immunosuppression status and possible prediction of immunotherapy response in melanoma patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2624. doi:10.1158/1538-7445.AM2017-2624
Collapse
|
44
|
Ascierto PA, Dummer R, Melero I, Palmieri G, Giannarelli D, Abrami E, Curvietto M, Simeone E, Grimaldi AM. SECOMBIT (sequential combo immuno and target therapy study): A three arms prospective, randomized phase II study to evaluate the best sequential approach with combo immunotherapy [ipilimumab (I) /nivolumab (N)] and combo target therapy [encorafenib (E)/binimetinib (B)] in patients with metastatic melanoma and BRAF mutation. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps9598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS9598 Background: Treatment of BRAF-mutated metastatic melanoma has dramatically changed with the introduction of targeted therapy (BRAF and MEK inhibitors) and immune-checkpoint blockade (anti-CTLA4, anti-PD-1, and anti-PD-L1). Target therapy has been associated with high response rates, but short-term responses. Conversely, treatment with immune checkpoint inhibitors was found to present with lower response rates, but long-term responses. Synergism has been demonstrated when targeted therapy is combined with immunotherapy. The risk of a high rate of toxicity limits the simultaneous combination of all the four compounds (target agents and immunomodulating monoclonal antibodies). Sequencing of these different combinations seems to be more feasible; finding the right treatment sequence represents an important issue to be addressed. Methods: Approximately, 230 patients with untreated, histologically-confirmed advanced melanoma (measurable disease by RECIST v1.1) and carrying the BRAFV600 mutation will be randomized to Arm A [E+B until disease progression (PD), followed by I+N], or Arm B (I+N until PD, followed by E+B) or Arm C (E+B for 8 weeks, followed by I+N until PD, followed by E+B until PD). Patients will receive the combo treatments with the following schedules: target therapy, E 450mg p.o. od + B 45mg p.o. bid; immunotherapy, I 3mg/kg + N 1mg/kg Q3w x 4 cycles, followed by N 3mg/kg Q2w. The OS (time from the date of randomization until death from any cause) is primary efficacy endpoint of the study. Secondary endpoints include total PFS (time from randomization until the second progression), survival at 2 and 3 years, best overall response rate, duration of response. About 90 patients will take part in the ancillary study for the evaluation of biomarkers on the biological samples available (biopsies + blood samples). 30 Sites in Europe will concur to enroll the patients in the trial. This study is open and currently enrolling patients. Clinical trial information: NCT02631447.
Collapse
|
45
|
Di Monta G, Caracò C, Simeone E, Grimaldi AM, Marone U, Di Marzo M, Vanella V, Festino L, Palla M, Mori S, Mozzillo N, Ascierto PA. Electrochemotherapy efficacy evaluation for treatment of locally advanced stage III cutaneous squamous cell carcinoma: a 22-cases retrospective analysis. J Transl Med 2017; 15:82. [PMID: 28441954 PMCID: PMC5405498 DOI: 10.1186/s12967-017-1186-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extensive squamous cell carcinoma has few therapeutic options. In such cases, electrochemotherapy involving electroporation combined with antineoplastic drug appears to be a new potential option and may be considered as an alternative treatment. The aim of this retrospective single-center study was to evaluate electrochemotherapy efficacy in treatment of locally advanced stage III squamous cell carcinoma, in which surgical procedures would have entailed wide tissue sacrifice. METHODS Clinical features, treatment response, and adverse effects were evaluated in 22 patients treated with electrochemotherapy with intravenous injection of bleomycin for extensive stage III cutaneous squamous cell carcinoma. Treatment of cutaneous lesions were performed according to the European Standard Operating Procedures of Electrochemotherapy. RESULTS Overall response to electrochemotherapy treatment was observed in 18 (81.8%) patients. Clinical response with necrosis of tumor mass was observed from the first session and lasted for all follow up period that ranged between 5 and 48 months with a median of 34 months. Overall the treatment was well tolerated with a very low complication rate. CONCLUSIONS Electrochemotherapy represents a safe and effective therapeutic approach, associated with a good tolerability.
Collapse
|
46
|
Queirolo P, Dozin B, Morabito A, Banelli B, Piccioli P, Fava C, Leo C, Carosio R, Laurent S, Fontana V, Ferrucci PF, Martinoli C, Cocorocchio E, Battaglia A, Ascierto PA, Capone M, Simeone E, De Galitiis F, Pagani E, Antonini Cappellini GC, Marchetti P, Guida M, Tommasi S, Mandalà M, Merelli B, Quaglino P, Fava P, Guidoboni M, Romani M, Spagnolo F, Pistillo MP. Association of CTLA-4 Gene Variants with Response to Therapy and Long-term Survival in Metastatic Melanoma Patients Treated with Ipilimumab: An Italian Melanoma Intergroup Study. Front Immunol 2017; 8:386. [PMID: 28446908 PMCID: PMC5388686 DOI: 10.3389/fimmu.2017.00386] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/20/2017] [Indexed: 01/14/2023] Open
Abstract
Ipilimumab (IPI) blocks CTLA-4 immune checkpoint resulting in T cell activation and enhanced antitumor immunity. IPI improves overall survival (OS) in 22% of patients with metastatic melanoma (MM). We investigated the association of CTLA-4 single nucleotide variants (SNVs) with best overall response (BOR) to IPI and OS in a cohort of 173 MM patients. Patients were genotyped for six CTLA-4 SNVs (−1661A>G, −1577G>A, −658C>T, −319C>T, +49A>G, and CT60G>A). We assessed the association between SNVs and BOR through multinomial logistic regression (MLR) and the prognostic effect of SNVs on OS through Kaplan–Meier method. Both −1577G>A and CT60G>A SNVs were found significantly associated with BOR. In particular, the proportion of responders was higher in G/G genotype while that of stable patients was higher in A/A genotype. The frequency of patients experiencing progression was similar in all genotypes. MLR evidenced a strong downward trend in the probability of responsiveness/progression, in comparison to disease stability, as a function of the allele A “dose” (0, 1, or 2) in both SNVs with reductions of about 70% (G/A vs G/G) and about 95% (A/A vs G/G). Moreover, −1577G/G and CT60G/G genotypes were associated with long-term OS, the surviving patients being at 3 years 29.8 and 30.8%, respectively, as compared to 12.9 and 14.4% of surviving patients carrying −1577G/A and CT60G/A, respectively. MM patients carrying −1577G/G or CT60G/G genotypes may benefit from IPI treatment in terms of BOR and long-term OS. These CTLA-4 SNVs may serve as potential biomarkers predictive of favorable outcome in this subset of patients.
Collapse
|
47
|
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] [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.
Collapse
|
48
|
Tallerico R, Cristiani CM, Staaf E, Garofalo C, Sottile R, Capone M, Pico de Coaña Y, Madonna G, Palella E, Wolodarski M, Carannante V, Mallardo D, Simeone E, Grimaldi AM, Johansson S, Frumento P, Gulletta E, Anichini A, Colucci F, Ciliberto G, Kiessling R, Kärre K, Ascierto PA, Carbone E. IL-15, TIM-3 and NK cells subsets predict responsiveness to anti-CTLA-4 treatment in melanoma patients. Oncoimmunology 2016; 6:e1261242. [PMID: 28344869 DOI: 10.1080/2162402x.2016.1261242] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/09/2016] [Accepted: 11/09/2016] [Indexed: 12/31/2022] Open
Abstract
Despite the success of immune checkpoint blockade in melanoma, the majority of patients do not respond. We hypothesized that the T and NK cell subset frequencies and expression levels of their receptors may predict responses and clinical outcome of anti-CTLA-4 treatment. We thus characterized the NK and T cell phenotype, as well as serum levels of several cytokines in 67 melanoma patients recruited in Italy and Sweden, using samples drawn prior to and during treatment. Survival correlated with low expression of the inhibitory receptor TIM-3 on circulating T and NK cells prior to and during treatment and with the increased frequency of mature circulating NK cells (defined as CD3-CD56dim CD16+) during treatment. Survival also correlated with low levels of IL-15 in the serum. Functional experiments in vitro demonstrated that sustained exposure to IL-15 enhanced the expression of PD-1 and TIM-3 on both T and NK cells, indicating a causative link between high IL-15 levels and enhanced expression of TIM-3 on these cells. Receptor blockade of TIM-3 improved NK cell-mediated elimination of melanoma metastasis cell lines in vitro. These observations may lead to the development of novel biomarkers to predict patient response to checkpoint blockade treatment. They also suggest that induction of additional checkpoints is a possibility that needs to be considered when treating melanoma patients with IL-15.
Collapse
|
49
|
Cesarone MR, Belcaro G, Agus G, Georgiev M, Errichi BM, Marinucci R, Errichi S, Filippini A, Pellegrini L, Ledda A, Vinciguerra G, Ricci A, Cipollone G, Lania M, Gizzi G, Ippolito E, Bavera P, Fano F, Dugall M, Adovasio R, Gallione L, Del Boccio G, Cornelli U, Steigerwalt R, Acerbi G, Cacchio M, Di Renzo A, Hosoi M, Stuard S, Corsi M, Di Ciano L, Simeone E, Collevecchio G, Grossi MG, Di Giambattista F, Carestia F, Zukowski A. Management of Superficial Vein Thrombosis and Thrombophlebitis: Status and Expert Opinion Document. Angiology 2016; 58 Suppl 1:7S-14S; discussion 14S-15S. [PMID: 17478877 DOI: 10.1177/0003319706297643] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Superficial vein thrombosis is characterized by clotting of superficial veins (ie, following direct trauma) with minimal inflammatory components. Superficial thrombophlebitis is a minimally thrombotic process of superficial veins associated with inflammatory changes and/or infection. Treatments generally include analgesics, elastic compression, anti-inflammatory agents, exercise and ambulation, and, in some cases, local or systemic anticoagulants. It is better to avoid bed rest and reduced mobility. Topical analgesia with nonsteroidal, anti-inflammatory creams applied locally to the superficial vein thrombosis/superficial thrombophlebitis area controls symptoms. Hirudoid cream (heparinoid) shortens the duration of signs/symptoms. Locally acting anticoagulants/antithrombotics (Viatromb®, Lipohep ®, spray Na-heparin) have positive effects on pain and on the reduction in thrombus size. Intravenous catheters should be changed every 24 to 48 hours (depending on venous flow and clinical parameters) to prevent superficial vein thrombosis/superficial thrombophlebitis and removed in case of events. Low molecular weight heparin prophylaxis and nitroglycerin patches distal to peripheral lines may reduce the incidence of superficial vein thrombosis/superficial thrombophlebitis in patients with vein catheters. In case of superficial vein thrombosis/superficial thrombophlebitis, vein lines should be removed. In neoplastic diseases and hematological disorders, anticoagulants may be necessary. Exercise reduces pain and the possibility of deep vein thrombosis. Only in cases in which pain is very severe is bed rest necessary. Deep vein thrombosis prophylaxis should be established in patients with reduced mobility. Antibiotics usually do not have a place in superficial vein thrombosis/superficial thrombophlebitis unless there are documented infections. Prevention of superficial vein thrombosis should be considered on the basis of patient's history and clinical evaluation.
Collapse
|
50
|
Ascierto PA, Vanella V, Grimaldi AM, Lucia F, Palla M, Simeone E, Mozzillo N. Complete response to nivolumab monotherapy in a treatment-naive, BRAF wild-type patient with advanced mucosal melanoma and elevated lactate dehydrogenase: a case report from a phase III trial. Cancer Immunol Immunother 2016; 65:1395-1400. [PMID: 27604993 PMCID: PMC11028877 DOI: 10.1007/s00262-016-1898-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 08/30/2016] [Indexed: 02/03/2023]
Abstract
The anti-PD-1 agent, nivolumab, has been approved both as monotherapy and in combination with ipilimumab for the treatment of unresectable or metastatic melanoma in the USA and European Union. Here we present the case of a patient with treatment-naive, metastatic mucosal melanoma and baseline LDH approximately seven times the upper limit of normal. The patient was enrolled in a clinical trial (CheckMate 066) and achieved a partial response, followed by a durable complete response with nivolumab treatment. The patient's LDH levels were documented in each cycle and dropped markedly within 2 months, when partial response to treatment was already evident. LDH levels remained low for the rest of follow-up, consistent with the ongoing complete response to treatment. The patient experienced only mild immune-related adverse events (grade 1-2), which included vitiligo and rash. This exceptional response suggests that patients with high LDH levels at baseline should be considered for nivolumab treatment. LDH levels, however, should not serve as a predictive marker of response to nivolumab. Moreover, this case suggests the need to identify patients who will achieve the greatest benefit from nivolumab monotherapy.
Collapse
|