Combination of pegylated liposomal doxorubicin plus gemcitabine in heavily pretreated metastatic breast cancer patients: Long-term results from a single institution experience

The combination of Pegylated Liposomal Doxorubicin (PLD) plus Gemcitabine (GEM) has been previously investigated in the treatment of metastatic breast cancer (MBC). PLD is a doxorubicin formulation with prolonged circulation time and better tissue distribution. GEM is a nucleoside analog with nonoverlapping toxicity compared to PLD. The aim of our study was to assess efficacy, toxicity, and long-term outcome of this combination. Patients with heavily treated MBC were retrospectively analyzed. Chemotherapy consisted of PLD 25 mg/m² and GEM 800 mg/m² day 1, on a three-week schedule. Cardiac function was evaluated baseline and during treatment. Radiological response was graded according to RECIST criteria v1.1. Toxicity was scored according to CTCAE v4.0. Progression-free survival (PFS) and overall survival (OS) were evaluated. From 2001 to 2014, 122 pts were included. Median age was 55 (range: 28-84). Median previous treatment schedules in the metastatic scenario were 3 (range: 1-15). Most patients received prior anthracyclines (85%). Median number of metastatic sites was 2 (range: 1-7). Median number of cycles delivered was 5 (range: 1-36). Overall response rate was 31% (5% complete responses; 26% partial responses). Stable and progressive diseases were observed in 32% and 26% of patients. Grade ≥3 neutropenia was observed in 29 patients (24%). Grade ≥3 hand-foot syndrome was detected in 17 patients (14%), mostly since cycle 3 (88%). Median cumulative PLD dose was 125 mg/m² . At a median follow-up of 101 months, median PFS and OS were 7 and 22 months, respectively. PLD-GEM combination achieves remarkable long-term outcomes with an acceptable toxicity profile in patients with MBC.

The inhibitor of differentiation-1 (Id1) enables lung cancer liver colonization through activation of an EMT program in tumor cells and establishment of the pre-metastatic niche

Id1 promotes carcinogenesis and metastasis, and predicts prognosis of non-small cell lung cancer (NSCLC)-adenocarcionoma patients. We hypothesized that Id1 may play a critical role in lung cancer colonization of the liver by affecting both tumor cells and the microenvironment. Depleted levels of Id1 in LLC (Lewis lung carcinoma cells, LLC shId1) significantly reduced cell proliferation and migration in vitro. Genetic loss of Id1 in the host tissue (Id1^-/- mice) impaired liver colonization and increased survival of Id1^-/- animals. Histologically, the presence of Id1 in tumor cells of liver metastasis was responsible for liver colonization. Microarray analysis comparing liver tumor nodules from Id1^+/+ mice and Id1^-/- mice injected with LLC control cells revealed that Id1 loss reduces the levels of EMT-related proteins, such as vimentin. In tissue microarrays containing 532 NSCLC patients' samples, we found that Id1 significantly correlated with vimentin and other EMT-related proteins. Id1 loss decreased the levels of vimentin, integrinβ1, TGFβ1 and snail, both in vitro and in vivo. Therefore, Id1 enables both LLC and the host microenvironment for an effective liver colonization, and may represent a novel therapeutic target to avoid NSCLC liver metastasis.

Lymphocytes and neutrophils count after two cycles and TTF1 expression as early outcome predictors during immunotherapy (IT) in stage IV non-small cell lung cancer (NSCLC) patients

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Background: NSCLC therapeutic paradigm has changed with immune checkpoint blockers. Biomarkers predicting clinical benefit are still lacking. As previously shown in melanoma, changes in absolute lymphocytes and neutrophils count (ALC and ANC) during IT (PD-1/PD-L1 inhibitors) may be related to response in NSCLC (Nakamuta et al, Oncotarget 2016). TTF1 expression has been associated with PD-L1 expression (Vieira et al, Lung Cancer 2016). We aimed to investigate TTF1 expression and changes in ALC and ANC after 2 cycles and their potential association with clinical outcomes to IT. Methods: We retrospectively analyzed 26 consecutive patients with stage IV NSCLC treated with IT at Clínica Universidad de Navarra (Spain) during 2016. Radiological response was evaluated according to RECIST v1.1. The potential correlation between ALC and ANC changes during the first two cycles and response to treatment [disease control rate (DCR) vs progression] was evaluated using Student’s T-test. Fisher’s exact test was used to study the association between changes in ALC ( < 1,000 vs > 1,000) and ANC ( < 4,000 vs > 4,000) after 2 cycles and response to IT. TTF-1 expression was correlated with treatment response. Overall survival (OS) was assessed with Kaplan-Meier analysis and Log-rank test according to ALC and ANC. Results: An ALC increase after 2 cycles was significantly associated with DCR compared to progression (192 vs -155; p = 0.043). ALC > 1,000 after 2 cycles was more frequent among patients experiencing DCR compared to progression (87% vs 50%; p = 0.07). ALC > 1,000 after 2 cycles was more frequently observed among patients with TTF1+ tumors (93% vs 55%; p = 0.03). Patients with ANC < 4,000 showed a longer median OS (NR vs 19.25 months; p = 0.03). TTF1 expression in adenocarcinoma (n = 18) was associated with response to IT (83% vs 16%, p = 0.01). Conclusions: Despite this retrospective small series’ limitations, our results show that ALC and ANC changes during IT and TTF1 expression may act as early predictors of clinical benefit in stage IV NSCLC patients treated with PD1/PD-L1 blockers. Our results warrant further investigation in larger prospective series.

Pazopanib-induced asymptomatic radiological acute pancreatitis: A case report

The universal clinical use of multi-targeted tyrosine kinase inhibitors (TKIs) in patients diagnosed with advanced renal cell carcinoma (RCC) has significantly prolonged their estimated survival times and their quality of life. However, several adverse side-effects associated predominantly with the inhibition of the vascular endothelial growth factor receptor by these drugs may prove to be potentially life-threatening. One adverse event that is only rarely observed with the use of TKIs in this clinical setting is acute pancreatitis. In the present study, to the best of our knowledge, the first case of asymptomatic radiological acute pancreatitis associated with the use of pazopanib in monotherapy in a patient with RCC is presented. In addition, a comprehensive review of the literature on this topic is provided, and certain potential measures that may aid in early diagnosis and treatment are discussed.

Abstract P2-04-01: Increased stromal lymphocytes in breast cancer patients with autologous dendritic cell vaccination plus neoadjuvant chemotherapy

Introduction: Higher levels of TILs after neoadjuvant chemotherapy (NAC) in the residual tumor have been related to a better outcome in BC patients. According to International TILs working group (2014), we have quantified stromal TILs in a cohort of patients treated with NAC plus dendritic cell vaccines (cohort V) (NCT01431196 plus an expanded cohort) and in an historic cohort of patients treated with the same NAC without V (cohort C) in order to assess if the addition autologous dendritic cell vaccination pulsed with patient´s tumor lysates helps to increase TILs in the residual BC specimen. Our previous data with these cohorts of patients have shown an improved pCR and the stimulation of lymphocytes population in the peripheral blood from cohort V.

Methods: Classification of molecular subtypes was performed by IHC. We evaluated percentage of TILs by three different pathologists using stained HE core biopsy sections in paired samples taken at diagnosis (preNAC) and after surgery (postNAC) in a prospectively defined retrospective analysis.

Results: 79 patients were evaluated (cohort C 42; cohort V 37). Patients from V cohort were younger (p=0.01). Cohorts were well balanced for AJCC staging, molecular subtypes (cohort C: LA 26%, LB 45%, TN 29%; cohort V: LA 24%, LB 40%, TN 35%), stromal TILs preNAC [cohort C: median 9 (range, 1-24); cohort V: 6 (1-34); p=0.38] and stromal TILs postNAC [cohort C: 9 (2-52); cohort V 8 (4-50); p=0. 94]. Seventy-seven patients (97%) underwent surgery (cohort C 41; cohort V 36). Pathologic CR was higher in Cohort V (27% vs 7%; p=0.02). However a superior pCR rate was detected in TNBC subtype (cohort C 27%; cohort V 58%; p=0.15). Patients from Cohort V experienced an increment of stromal TILs after NAC plus autologous dendritic cell vaccination (preNAC: 6 (1-34); postNAC 8 (4-50); p=0.03), especially in TNBC [preNAC 14 (1-34); postNAC 30 (10-50); p=0.2]. A correlation analysis by Pearson´s R coefficient stated a strong association in V cohort between stromal TILs preNAC and postNAC (R=0.83) as well as a moderate correlation between stromal TILs postNAC and and molecular subtypes (R=0.6).

Table 1. Differences in Stromal TILs between studied cohorts PreNAC (median, range)PostNAC (median, range)P valueCohort C9 (1-66)9 (2-52)0.22Cohort V6 (1-34)8 (4-50)0.03*Cohort C LA LB TN5 (1-10) 9 (1-24) 12 (10-24)6 (3-12) 10 (2-40) 13 (5-52)0.69 0.17 1Cohort V LA LB TN5 (2-17) 6 (1-15) 14 (1-347 (4-12) 7 (4-27) 30 (10-50)0.18 0.08 0.2

Conclusion: Pathological complete responses were higher in BC patients treated with neoadjuvant chemotherapy plus active immunotherapy. The addition of autologous dendritic cell vaccines to NAC increases significantly stromal TILs in breast cancer patients.

Citation Format: Baraibar I, Martin-Romano P, Mejías L, Perez Solans B, Ceniceros L, Legazpi J, Gardeazabal I, Inoges S, Lopez-diaz A, Idoate M, Cordoba A, Santisteban M. Increased stromal lymphocytes in breast cancer patients with autologous dendritic cell vaccination plus neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-04-01.

Eribulin and carboplatin in heavily pretreated patients with metastatic breast cancer: A single institution experience

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Background: In recent years many drug combinations have demonstrated clinical activity in heavily pretreated patients (pts) with metastatic breast cancer (MBC). Eribulin (E) in monotherapy has shown a beneficial effect in overall survival (OS) with slight rate of objective responses (OR) and poor effect in progression free survival (PFS). The Eribulin – Carboplatin (Cb) combination has been studied in other types of tumors in a phase Ib with promising results. We initiated an exploratory program with an off-label combination of E – Cb in pts with visceral disease and ECOG < 2. Methods: We retrospectively analyzed pts with MBC previously treated with anthracyclines, taxanes, and Capecitabine. Chemotherapy regimen consisted of E 1.1mg/m2 on days 1 and 8 and Cb AUC: 5 on day 1 every 21 days. Toxicity was assessed according to CTC criteria v 4.0. OR, PFS and OS rates were also evaluated. RECIST criteria were used to appraise radiological response. Results: Treatment was delivered in 10 pts. Median (M) age was 56 (range, 39-65). Pts characteristics were defined as follows: ECOG 0 (1 pt), 1 (6 pts) and 2 (3 pts); histological subtypes: luminal 9 pts and Her-2, 1 pt. M of previous lines was 7 (3-11). M of metastatic localizations were 3 (1-4). M of administered cycles was 6’5 (1-10). Grade 2 toxicity was asthenia 40%, peripheral neuropathy 10% and nausea - vomiting 10%. G 3 anemia and thrombopenia were noted in 20%. G 3-4 neutropenia was observed in 5 pts. Two pts required hospital admission due to febrile neutropenia. OR rate: complete response 10%, partial response 50% and stable disease 40%. Biochemical response rate was 80%. M of follow-up was 11 months, with M PFS and OS of 8 (4-11) and 18 months (4-18) respectively. Conclusions: Eribulin and Carboplatin is feasible, achieving remarkable response and survival rates with an acceptable toxicity profile in heavily pretreated patients with metastatic breast cancer. Preliminary results are promising and encourage us to continue recruiting patients.

A Semliki forest virus vector engineered to express IFNα induces efficient elimination of established tumors

Semliki Forest virus (SFV) represents a promising gene therapy vector for tumor treatment, because it produces high levels of recombinant therapeutic proteins while inducing apoptosis in infected cells. In this study, we constructed a SFV vector expressing murine interferon alpha (IFNα). IFNα displays antitumor activity mainly by enhancing an antitumor immune response, as well as by a direct antiproliferative effect. In spite of the antiviral activity of IFNα, SFV-IFN could be produced in BHK cells at high titers. This vector was able to infect TC-1 cells, a tumor cell line expressing E6 and E7 proteins of human papillomavirus, leading to high production of IFNα both in vitro and in vivo. When injected into subcutaneous TC-1 tumors implanted in mice, SFV-IFN was able to induce an E7-specific cytotoxic T lymphocyte response, and to modify tumor infiltrating immune cells, reducing the percentage of T regulatory cells and activating myeloid cells. As a consequence, SFV-IFN was able to eradicate 58% of established tumors treated 21 days after implantation with long-term tumor-free survival and very low toxicity. SFV-IFN was also able to induce significant antitumor responses in a subcutaneous tumor model of murine colon adenocarcimoma. These data suggest that local production of IFNα by intratumoral injection of recombinant SFV-IFN could represent a potent new strategy to treat tumors in patients.